Relocation module and methods for surgical equipment

ABSTRACT

Modules for housing electronic and electromechanical medical equipment including a system to measure and record administration of one or more IV medications or fluids for IV administration.

PRIORITY

This application is a continuation of U.S. application Ser. No.17/874,998, filed Jul. 27, 2022, which is a continuation of U.S.application Ser. No. 17/376,469, filed Jul. 15, 2021, now U.S. Pat. No.11,219,570 B2, which is a continuation-in-part of U.S. application Ser.No. 17/199,722, filed Mar. 12, 2021, now U.S. Pat. No. 11,173,089 B2,which is a continuation of U.S. application Ser. No. 17/092,681, filedNov. 9, 2020, now issued as U.S. Pat. No. 10,993,865, which is acontinuation of U.S. application Ser. No. 16/879,406, filed May 20,2020, now issued as U.S. Pat. No. 10,869,800, which is acontinuation-in-part of U.S. application Ser. No. 16/601,924, filed Oct.15, 2019, now issued as U.S. Pat. No. 10,702,436, which is acontinuation of U.S. application Ser. No. 16/593,033, filed Oct. 4,2019, now issued as U.S. Pat. No. 10,653,577, which is a continuation ofU.S. application Ser. No. 16/364,884, filed Mar. 26, 2019, now issued asU.S. Pat. No. 10,507,153, which claims the benefit of priority to U.S.Provisional Patent Application 62/782,901, filed Dec. 20, 2018. U.S.application Ser. No. 17/199,722, filed Mar. 12, 2021, is also acontinuation-in-part of U.S. application Ser. No. 15/935,524, filed Mar.26, 2018, now issued as U.S. Pat. No. 10,512,191.

This application is also a continuation-in-part of U.S. application Ser.No. 17/245,942, filed Apr. 30, 2021, which is a continuation-in-part ofU.S. application Ser. No. 17/167,681, filed Feb. 4, 2021, now U.S. Pat.No. 11,160,710 B2, which is a continuation-in-part of U.S. applicationSer. No. 17/092,681, filed Nov. 9, 2020, now issued as U.S. Pat. No.10,993,865, which is a continuation of U.S. application Ser. No.16/879,406, filed May 20, 2020, now issued as U.S. Pat. No. 10,869,800.

The disclosures of each of these applications is incorporated herein byreference in its entirety.

TECHNICAL FIELD

This document pertains generally, but not by way of limitation, tosystems and methods for improving safety in operating rooms andhospitals. In particular, the systems and methods described herein mayinclude but are not limited to, anesthetic, surgical and medicalequipment storage and operational data capture, automated anesthetic andpatient monitoring data capture and electronic record input.

BACKGROUND

Anesthesia monitors and equipment as well as surgical equipment havebeen invented, developed and sporadically introduced into surgicalpractice over more than a century. This equipment is made by a widevariety of companies who have no incentive to coordinate with oneanother to create the most efficient operating room. Equipmentthroughout the operating room has been placed in one location oranother, generally without a plan and then decades later, is stillsitting in that unplanned location.

Over the past 20 years, there has been a gradual movement to replacingpaper anesthetic records with electronic anesthetic records (EAR). Thedigital electronic data outputs of the patient's physiologic monitorshave been relatively easy to input into the EAR. However, the identity,dosing and timing of IV and inhaled drug administration, IV fluidadministration, oxygen and ventilation gas administration and anestheticevents such as intubation have required manual input to the EAR by wayof a computer keyboard and mouse. Blood, fluid and urine outputs havealso required manual input to the EAR by way of a computer keyboard andmouse. The surgical equipment scattered around the operating room eitherdoes not produce a digital output that could memorialize the equipment'soperation to the electronic record, that output is not automaticallycaptured, or the output is not provided in a way that providesmeaningful con text.

Carefully observing the patient in various conditions and situationsincluding surgery has been an important source medical information forcenturies. However, in this age of electronic monitoring, patientobservation by the healthcare provider is becoming a lost art that isinfrequently done and if it is done it may not be entered into therecord so the information is lost.

SUMMARY

In some examples, the automated data consolidation module of thisdisclosure minimizes “garbage in” of healthcare “big data” by automatingthe data input process.

As a result of the current medical practices described, the majority ofthe input to the electronic anesthetic and medical records has been thedata from the vital signs monitors, recording the patient's “response.”The “dose” events (things that are given or done to the patient leadingto the “response”) are manually entered into the record, resulting inmistakes, omissions and no temporal correlation between the dose andresponse. The incomplete and inaccurate records make any analysis withartificial intelligence and machine learning software problematic,either for that individual patient or for “big data” analysis ofpopulations of patients.

This document pertains generally to systems and methods for improvingsafety for patients receiving intravenous (IV) medications and fluids,by avoiding medication or fluid errors and documenting theadministration. This document pertains generally, but not by way oflimitation, to systems and methods for constructing granular(beat-by-beat) anesthetic, surgical and patient records that includeboth “dose” events (things that are given or done to the patient) and“response” events (inputs from electronic monitors, measurement devicesand machine vision “observations”). The dose and response events areprecisely temporally related and recorded in the patient's electronicrecord and may be pooled with the records of other patients in adatabase that can be analyzed with artificial intelligence and machinelearning software.

Illustrative examples of an automated data consolidation module thatsystematizes surgical safety for patients and OR personnel. In someexamples, this automated data consolidation module is designed to housenearly all of the operating room patient monitors and support equipment.Even dissimilar types of equipment that are normally kept separate fromone another. In some examples, this unique automated data consolidationmodule is specially designed to fit next to and under the arm-board ofthe surgical table a location traditionally occupied by an IV pole. Forthe past 100 years, this location has been a wasted “no-man's land”between the anesthesia and surgical sides of the operating room. Inreality, the unique space next to and under the arm-board, is truly the“prime real estate” of the entire operating room: it is immediatelyadjacent the patient for optimal monitoring while simultaneouslymaintaining observation of the patient and surgical procedure; equipmentcontrols can be conveniently accessed by both the anesthesia andsurgical staff; short cables and hoses are adequate to reach thepatient; and it is uniquely accessible from both the anesthesia andsurgical sides of the anesthesia screen. The unique space next to andunder the arm-board is the only location in the entire operating roomwhere cables, cords and hoses from both the anesthesia side and thesterile surgical field side, do not need to traverse the floor or eventouch the floor in order to connect to their respective monitor orpatient support equipment—truly a remarkable location that has beenwasted by conventional systems.

In some examples, an illustrative automated data consolidation modulecan house both anesthesia related and non-anesthesia related equipment.In some examples, the illustrative relocation module can house a varietyof non-proprietary OR equipment such as patient vital sign monitors,electro-surgical generators, anesthesia machines and mechanicalventilators. In some examples, the automated data consolidation moduleis designed to also house newer proprietary safety equipment such as:air-free electric patient warming, surgical smoke evacuation, wastealcohol and oxygen evacuation, evacuation of the flow-boundarydead-zones that cause disruption of the OR ventilation and theevacuation and processing of waste heat and air discharged from ORequipment. In some examples, this automated data consolidation modulemay also house dissimilar equipment (e.g., unrelated to anesthesiamonitoring) such as: air mattress controls and air pumps; sequentialcompression legging controls and air pumps; capacitive couplingelectrosurgical grounding, RFID counting and detection of surgicalsponges; the waste blood and fluid disposal systems; and “hover”mattress inflators. Any of these devices may be stored in the automateddata consolidation module together with (or without) anesthesiaequipment.

In some examples, the automated data consolidation module is aspecialized and optimally shaped rack for holding and protecting thepatient monitors and other electronic and electromechanical surgicalequipment, in a unique location. A location that is very different fromjust setting anesthesia monitors on top of the anesthesia machine andscattering other equipment across the floor of the operating room. Theautomated data consolidation module may be used anywhere throughout thehospital or long term care settings.

The various pieces of electronic and electromechanical equipment housedwithin the automated data consolidation module disclosed herein canproduce relatively large amounts of waste heat. In some examples, theautomated data consolidation module may include a waste heat managementsystem to safely dispose of the waste heat created by the electronic andelectromechanical equipment housed within the automated dataconsolidation module.

It would be difficult or even impossible to manage the uncontained wasteheat produced by electronic and electromechanical equipment mounted on asimple open rack because it can escape in any direction. In someexamples, the module can include a “cowling” covering some or all of theouter surface. The cowling not only protects the equipment fromaccidental fluid damage but also confines the waste heat from theelectronic and electromechanical equipment mounted within the module, tothe inside of the module and cowling. In some examples, the confinedwaste heat can then be safely managed.

In some examples, the cowling cover of the automated data consolidationmodule can form or support a waste heat management system. In someexamples, the cowling can be provided on an inner surface of thehousing. In some examples, the cowling can be described as aninsulation. In some examples, the housing can include other types ofinsulation from heat and/or water. Any suitable type of insulatedhousing suitable for use in a surgical field can be provided.

In some examples, the automated data consolidation module of the instantinvention may also contain the components of the anesthesia gas machine.So-called “gas machines” are relatively simple assortments of piping,valves, flow meters, vaporizers and a ventilator. These could be locatedwithin the automated data consolidation module or attached to theautomated data consolidation module for further consolidation ofequipment and for improved access to the patient.

In some examples, locating the anesthesia machine in or on the automateddata consolidation module allows direct access for and sensors andmonitors related to the anesthesia machine, to input data to theelectronic anesthetic record being recorded by equipment in theautomated dose/response record system.

In some examples, the collection canisters for waste fluid and blood maybe conveniently mounted on the module.

In some examples, the controls and display screens for the surgicalequipment housed in the automated data consolidation module may bewirelessly connected to a portable display screen such as an iPad or“smart tablet,” for convenient access by the nurse anywhere in the room.A remote display screen can also allow remote supervision andconsultation.

In some examples the automated data consolidation module may be locatednext to the patient's bed in the ICU, ER, on the ward or in long termcare. While most of the data collected by the automated dataconsolidation module will occur in the acute care setting, it should beunderstood that the automated data consolidation module concept forautomatically collecting and consolidating data from a wide variety ofdata sources including monitors and other medical equipment, can beapplied throughout the healthcare delivery system.

Doctors and nurses dislike record keeping and the switch to theelectronic record has made the act of record keeping more difficult andtime consuming. Entering the electronic record into the computersometime after the event occurred and the case has settled down, is notonly distracting from patient care but leads to inaccurate records. Handentered records also bypass the opportunity for the computer to add topatient safety by checking drug identities, dosages, side effects,allergies and alerting the clinician to potential problems or evenphysically stopping the drug administration. Manually entered recordsare not useful for managing drug inventories because a given medicationadministration is not tied to a specific drug bottle or syringe.Finally, the computer mouse and keyboards have been shown to becontaminated by a wide variety of infective organisms and are virtuallyimpossible to clean. Automatic anesthetic data entry to the EAR wouldimprove patient safety, improve clinician job satisfaction and improveOR inventory management.

In general, doctors and nurses are not interested in replacingthemselves and their jobs with automated drug delivery or automatedanesthesia systems. However, they may be more open to automated recordkeeping. The challenge with automated record keeping is automating thedata input that documents the numerous activities, anesthesia relatedevents, fluid, gas and medication administration that constitute ananesthetic experience or another medical situation.

The second challenge in implementing an automated electronic anestheticrecord (EAR) or automated electronic medical record (EMR) is to force aslittle change in routine as possible onto the anesthesiologist and otherclinicians using this system. Anesthesiologists and surgeons arenotoriously tradition-bound and resistant to any changes in their “triedand true” way of doing things. Therefore, a successful automated EARmust interact seamlessly with current anesthesia practices and operatingroom workflow without causing any disruptions.

The concept of “garbage in, garbage out” is of the utmost importance formedical algorithms trained on healthcare datasets. The majority of datacategories in the acute care setting are manually inputted, basically adigitized paper record. Manually inputted data is sporadic and prone toerrors and omissions. It is also not time-stamped for temporalcorrelations. The result is that when those data are aggregated into a“big data” database, the data is incomplete, inconsistent, missing andoften unusable. Further, clinicians hate the data entry part of theirjobs, seeing it as time consuming and distracting from patient care.Several studies have linked manual data entry to the electronic recordas a significant contributor to physician burnout.

In some examples, the automated data consolidation module of thisdisclosure includes a system for automatically measuring and recordingthe administration of IV medications and fluids. The system forautomatically measuring and recording the administration of IVmedications and fluids can include one or more sensors, such as one ormore of a barcode reader and an UM interrogator for accuratelyidentifying a medication or fluid for IV administration.

In some examples, the system for automatically measuring and recordingthe administration of IV medications and fluids can also include one ormore digital cameras with machine vision software (“machine vision”) foraccurately measuring the volume of medication administered from asyringe or fluid administered from an IV bag through a drip chamber intoan IV tubing. The digital cameras with machine vision softwareessentially duplicate the clinician's vision of an activity, injectionof a drug from a syringe for example, without interfering in the normalactivity and yet allows automatic recording of the activity in the EAR.The machine vision software can include one or more machine-readablemediums that when implemented on hardware processing circuitry of thesystem or in electrical communication with the system, can perform thefunctions described herein.

In some examples, the automated data consolidation module of thisdisclosure uses machine vision to unobtrusively “observe” the flow rateof the ventilation gas flow meters and inhaled anesthetic vaporizers.

In some examples, the automated data consolidation module of thisdisclosure captures input data from the blood and fluid collection andurine output collection systems of this disclosure.

In some examples, the automated data consolidation module of thisdisclosure lets the computer (e.g., a processor and memory forperforming instructions) add to patient safety by checking drugidentities, dosages, side effects, allergies, the patients' medicalhistory and vital signs and alerting the clinician to potential problemsor even physically stopping the drug administration. In some examples,the automated data consolidation module of this disclosure eliminatesmedication errors by checking the drug to be injected against thephysician's medication orders before the injection can occur. In someexamples, the automated data consolidation module of this disclosure isuseful for managing drug inventories because a given medicationadministration is tied to a specific drug bottle or syringe.

In some examples, the automated data consolidation module of thisdisclosure may also automatically record and display many otherfunctions including but not limited to: IV fluid administration,medication infusions, the patient's vital signs, urine output, bloodloss, ventilator settings, inspired gases, electrosurgical settings,pneumoperitoneum insufflation settings, RFD surgical sponge counts,surgical information and video, dialysis or other medical procedureinformation and patient activity.

“Dose/response” is one of the most basic of all medical processes. Sincethe beginning of medical practice, both the art and science of medicinehave relied on giving something to the patient (a medicine for example)or doing something to the patient (mechanical ventilation or surgery forexample)—the “dose”, and then observing the patient's “response.” Theproblem now seen with electronic records is that the only data that istimely recorded is the “response” data provided by the physiologicmonitors. Even that response data is frequently not recordedbeat-by-beat but rather intermittently recorded every 5 minutes or 30minutes or 4 hours for example. All of the “dose” data is entered intothe electronic record by hand and therefore is prone to mistakes,omissions and unknown timing. Therefore, with current EMRs, the dose andresponse data cannot be temporally correlated with any accuracy, vastlyreducing the analytical and predictive value of the electronic databaseand record.

In some examples, the automated data consolidation module of thisdisclosure includes systems and methods for constructing granular(beat-by-beat, second-by-second) anesthetic, surgical and patientrecords that include both “dose” events the things that are given ordone to the patient (inputs from medication injection and fluidmonitors, various support equipment and machine vision “observations”for example) and “response” events (inputs from electronic monitors,measurement devices and machine vision “observations” for example). Insome examples, the invention of this disclosure automatically entersboth dose and response events into the electronic record. In someexamples, the invention of this disclosure automatically enters bothdose and response events into the electronic record and temporallycorrelates the dose and response events, such as but not limited to,when they are recorded. In some examples, the automatically entered,temporally correlated dose and response events in the patient'selectronic record may be analyzed by artificial intelligence (AI) and/ormachine learning (ML) software stored in a memory of a storage deviceelectrically coupled to the processing circuitry of the module forimmediate advice, alerts and feedback to the clinician. In someexamples, the automatically entered, temporally correlated dose andresponse events in the patient's electronic record may be pooled withthe records of other patients in a database that can be analyzed withartificial intelligence and machine learning software.

Machine Learning (ML) is an application that provides computer systemsthe ability to perform tasks, without explicitly being programmed, bymaking inferences based on patterns found in the analysis of data.Machine learning explores the study and construction of algorithms e.g.,tools), that may learn from existing data and make predictions about newdata. Such machine-learning algorithms operate by building an ML modelfrom example training data, in order to make data-driven predictions ordecisions expressed as outputs or assessments. The principles presentedherein may be applied using any suitable machine-learning tools.

In some examples, the AI or ML software can compare dose and responseevents from different periods of time for the same patient to learn andidentify the particular patient's responses. In some examples themachine learning software can be trained to identify a patient'sresponses using training obtained from a plurality of patients that mayinclude or not include the patient being monitored. Any suitable AI orML can be implemented to interpret the data generated by the module.Current methods of obtaining data in medical settings cannot generate,store or aggregate such data for analysis using AI or ML. Thus, thedose-response systems described herein provide a technical solution to atechnical problem.

Machine vision cameras and software are very good at measuringdistances, movements, sizes, looking for defects, fluid levels, precisecolors and many other quality measurements of manufactured products.Machine vision cameras and software can also be “taught” through AI andML to analyze complex and rapidly evolving scenes, such as those infront of a car driving down the road.

In some examples, the automated data consolidation module of thisdisclosure includes novel systems and methods for using machine visioncameras and software to “observe” the patient. If the patient is insurgery, the patient's head may be the focus of the observation. In someexamples, during surgery the machine vision cameras and software may be“looking” for dose events including but not limited to mask ventilationor endotracheal intubation. In some examples, during surgery the machinevision cameras and software may be “looking” for response eventsincluding but not limited to grimacing or tearing or coughing or changesin skin color.

If the patient is on the ward or in the nursing home or other long-termcare facility, the whole patient may be the focus of the observation. Insome examples, if the patient is on the ward or in the nursing home orother long-term care facility the machine vision cameras, processingcircuitry and software may be configured to “look” for dose events(e.g., sense) including but not limited to repositioning the patient,suctioning the airway or assisting the patient out of bed or any othernursing procedure, eating and drinking.

In some examples, if the patient is on the ward or in the nursing homeor other long-term care facility (including at home) the machine visioncameras, processing circuitry and software may be configured to “look”for response events (e.g., sense) including but not limited torestlessness or getting out of bed without assistance or coughing orbreathing pattern. In some examples, the system can go beyondtraditional physiologic monitors. Even physiologic response informationsuch as pain may be detected by facial expression analysis.

In some examples, vital signs such as heart rate, respiration rate,blood oxygen saturation and temperature can be measured (e.g., sensed,monitored) remotely via camera-based methods. Vital signs can beextracted from the optical detection of blood-induced skin colorvariations—remote photoplethysmography (rPPG).

In some examples, the automated data consolidation module may allowremote viewing of the displayed patient information. In some examples,the remotely displayed patient information may be used for remotemedical supervision such as an anesthesiologist providing remotesupervision to a nurse anesthetist who is administering the anesthetic.In some examples, the remotely displayed patient information may be usedfor remote medical consultation. In some examples, the remotelydisplayed patient information may be used to document the involvement ofremote medical supervision or consultation for billing purposes.

In some examples, the automated data consolidation module allows rulesto be applied to the various medical equipment that is housed within themodule, mounted on the module, or is in electrical communication with orin wireless communication with the module. In some examples, the rulescan include one or more of the following: that all equipment producedata reflecting the equipment's operating parameters and sensor inputs,the data is produced in prescribed data formats, the data include allprescribed input record fields for that specific type of equipment, thedata is instantly and continuously provided.

In some examples, the automated data consolidation module includesprocessing circuitry and software that accept the data inputted from thevarious medical equipment. In some examples, the processing circuitryand software can translate data that is not inputted in the prescribedformat. In some examples, the processing circuitry and software can addtime stamps to the data to add a temporal context. In some examples, theprocessing circuitry and software can do data “filtering” in thepresence of large size data to discard information that is not usefulfor healthcare monitoring based on a defined criterion. This may includefor example, intermittently recording data that changes slowly such asthe patient's temperature, rather than continuously recording. In someexamples, the processing circuitry and software can do data “cleaning”such as normalization, noise reduction and missing data management.Sensor fusion is a technique that may be utilized to simultaneouslyanalyze data from multiple sensors, in order to detect erroneous datafrom a single sensor. In some examples, the processing circuitry andsoftware can be used in many other ways to cleanse, organize and preparethe input data.

In some examples, the processing circuitry and software execute “streamprocessing” for applications requiring real-time feedback. In someexamples, streaming data analytics in healthcare can be defined as asystematic use of continuous waveform and related medical recordinformation developed through applied analytical disciplines, to drivedecision making for the patient care.

In some examples, when the objective is to deliver data to a “big data”database, the data must be pooled. Data in the “raw” state needs to beprocessed or transformed. In a service-oriented architectural approach,the data may stay raw and services are used to call, retrieve andprocess the data. In the data warehousing approach, data from varioussources is aggregated and made ready for processing, although the datais not available in real-time. The steps of extract, transform, and load(ETL) can be used to cleans and ready data from diverse sources.

In some examples, with “big data” database data, the processingcircuitry and software may execute “batch processing,” analyzing andprocessing the data over a specified period of time. Batch processingaims to process a high volume of data by collecting and storing batchesto be analyzed in order to generate results. In some examples, theprocessing circuitry and software can serve as a “node” in batchcomputing, where big data is split into small pieces that aredistributed to multiple nodes in order to obtain intermediate results.Once data processing by nodes is terminated, outcomes will be aggregatedin order to generate the final results.

BRIEF DESCRIPTION OF THE DRAWINGS

In the drawings, which are not necessarily drawn to scale, like numeralsmay describe similar components in different views. Like numerals havingdifferent letter suffixes may represent different instances of similarcomponents. The drawings illustrate generally, by way of example, butnot by way of limitation, various examples discussed in the presentdocument. Any combination of the features shown and described in thisdisclosure, including combinations of fewer or more features is withinthe content of this disclosure. Modules, systems and methods includingindividual features described herein, without combinations of featuresas shown in the examples (for the sake of brevity), are also within thescope of this disclosure.

FIG. 1 illustrates an isometric view of an example module including asystem for generating an automated electronic anesthetic record locatedproximate to a patient, in accordance with at least one example of thisdisclosure.

FIG. 2 illustrates an isometric view of an example module including asystem for generating an automated electronic anesthetic record locatedproximate to a patient, in accordance with at least one example of thisdisclosure.

FIG. 3 illustrates a plan view of an example of preloaded syringes thatcan be used with the system of FIGS. 1 and 2 , in accordance with atleast one example of this disclosure.

FIG. 4 illustrates a side view of an example medication identificationand measurement system and a syringe that can be used with the system ofFIGS. 1 and 2 , to monitor drug delivery, in accordance with at leastone example of this disclosure.

FIG. 5 illustrates a cross-sectional view of the medicationidentification and measurement system and a syringe (not shown incross-section) of FIG. 4 , taken along line 5-5, in accordance with atleast one example of this disclosure.

FIG. 6 illustrates a side view of a second example medicationidentification and measurement system and a syringe that can be usedwith the system of FIGS. 1 and 2 , in accordance with at least oneexample of this disclosure.

FIG. 7 illustrates a cross-sectional view of the second example of amedication identification and measurement system and the syringe (notshown in cross-section) of FIG. 6 , taken along line 7-7, in accordancewith at least one example of this disclosure.

FIG. 8 illustrates a side view of a third example of a medicationidentification and measurement system and a syringe that can be usedwith the system of FIGS. 1 and 2 , in accordance with at least oneexample of this disclosure.

FIG. 9 illustrates a cross-sectional view of the third example of amedication identification and measurement system and the syringe (notshown in cross-section) of FIG. 8 , taken along line 9-9, in accordancewith at least one example of this disclosure.

FIG. 10 illustrates an example injection port cassette that can be usedwith the system of FIGS. 1 and 2 , as detailed in FIGS. 5, 7 and 9 , inaccordance with at least one example of this disclosure.

FIG. 11 illustrates a plan view of an example of healthcare provider IDbadges that can be used with the system of FIGS. 1 and 2 , in accordancewith at least one example of this disclosure.

FIG. 12 illustrates an isometric view of another example moduleincluding a system for generating an automated electronic anestheticrecord located proximate to a patient, in accordance with at least oneexample of this disclosure.

FIG. 13 illustrates an isometric view of another example moduleincluding a system for generating an automated electronic anestheticrecord located proximate to a patient, in accordance with at least oneexample of this disclosure.

FIG. 14 illustrates a side view of an example IV fluid identificationand measurement system that can be used with the systems of FIGS. 1 and2 , and injection port cassette of FIG. 10 , in accordance with at leastone example of this disclosure.

FIG. 15 illustrates generally an example of a block diagram of a machine(e.g., of module 101, 201) upon which any one or more of the techniques(e.g., methodologies) discussed herein may perform in accordance with atleast one example of this disclosure.

FIG. 16 is a flow chart illustrating a technique of IV fluididentification and measurement, in accordance with at least one exampleof this disclosure.

FIG. 17 is a second flow chart illustrating the technique of TV fluididentification and measurement, in accordance with at least one exampleof this disclosure.

FIG. 18 is a flow chart illustrating a technique of medicationidentification and measurement, in accordance with at least one exampleof this disclosure.

FIG. 19 is a second flow chart illustrating a technique of medicationidentification and measurement, in accordance with at least one exampleof this disclosure.

FIG. 20 is a flow chart illustrating a second technique of IV fluididentification and measurement including safety and security aspects, inaccordance with at least one example of this disclosure.

FIG. 21 is a second flow chart illustrating a second technique of IVfluid identification and measurement including safety and securityaspects, in accordance with at least one example of this disclosure.

FIG. 22 illustrates generally an example of a block diagram of vendingsystem and a medication delivery system of FIGS. 1-21 upon which any oneor more of the techniques (e.g., methodologies) discussed herein mayperform in accordance with at least one example of this disclosure.

FIG. 23 is a flow chart illustrating a method for assessing physiologicevents, in accordance with at least one example of this disclosure.

FIG. 24 is a flow chart illustrating a method for temporally correlatingand analyzing dose-response events, in accordance with at least oneexample of this disclosure.

FIG. 25 is a flow chart illustrating a method for streaming healthcaredata.

FIG. 26 is a block diagram illustrating an example conceptualarchitecture of big data analytics.

DETAILED DESCRIPTION

The following detailed description is exemplary in nature and is notintended to limit the scope, applicability, or configuration of theinvention in any way. Rather, the following description providespractical illustrations for implementing exemplary examples of thepresent invention. Examples of constructions, materials, dimensions, andmanufacturing processes are provided for selected elements, and allother elements employ that which is known to those of skill in the fieldof the invention. Those skilled in the art will recognize that many ofthe examples provided have suitable alternatives that can be utilized.

As described herein, operably coupled can include, but is not limitedto, any suitable coupling, such as a fluid (e.g., liquid, gas) coupling,an electrical coupling or a mechanical coupling that enables elementsdescribed herein to be coupled to each other and/or to operate togetherwith one another (e.g., function together).

“Dose/response” can be a useful medical tool. Dose/response involvesgiving something to the patient (a medicine for example) or doingsomething to the patient (mechanical ventilation or surgery forexample)—the “dose”, and then observing the patient's “response.”

Throughout this disclosure, the word “dose” or “dose event” meanssomething that was given to or done to the patient. In some examples,“dose events” involve giving something to the patient including but notlimited to: the injection or ingestion of medications, the infusion ofmedications, the infusion of IV fluids, inspired gases such as oxygen ornitrous oxide or volatile anesthetics or nitric oxide.

In some examples, “dose events” are things done to the patient,including but not limited to: mask ventilation, tracheal intubation,mechanical ventilation, pneumoperitoneum insufflation, patientpositioning and surgery.

In some examples, “dose events” are applications of electricity to thepatient, including but not limited to: train-of-four determination ofmuscle relaxation, nerve conduction studies, cardiac pacing,cardioversion, electrical stimulation of nerves and electroconvulsivetherapy. Many other “dose events” are anticipated.

Throughout this disclosure, the word “response” or “response event”means a physiologic, reflexive motor response or volitional motorresponse from the patient. In some examples, “response events” involvemeasuring a physiologic response of the patient measured by thephysiologic monitors, including but not limited to: an electrocardiogram(EKG), pulse oximetry, blood pressure, end tidal gases,electroencephalogram (EEG), bispectral index (BIS), laboratory bloodstudies, urine output, blood loss and pulmonary compliance.

In some examples, “response events” involve measuring a motor responseof the patient, including but not limited to: a train-of-four,grimacing, coughing, movements of many sorts and tearing, that may bemeasured by a machine vision camera and software.

FIG. 1 illustrates an isometric view of an example automated dataconsolidation module 100 for generating an automated electronicanesthetic record (EAR) or electronic medical record (EMR) locatedproximate to a patient. Some aspects of FIG. 1 are also described withrespect to the description of other figures, including FIG. 14 .

As shown in FIG. 1 , the automated data consolidation module 100 may beattached to and portions can be stored within a module 101. The module101 can conveniently provide direct access to the patient 102. An TVpole 105 may provide a convenient mounting support location for theautomated data consolidation module for IV medications 100 (hereinafter,“automated data consolidation module 100”). In some examples, thecomponents and systems of the automated data consolidation module 100 ofthis disclosure can be supported by other mounting supports, includingbut not limited to a boom-mounted rack system, a wheeled rack system anda bed 103 mounting bracket. One or more computers including processingcircuitry 157, of the automated data consolidation module 100 of thisdisclosure may be conveniently and safely housed inside the module 101.

In some examples, it is anticipated that some or all of the componentsof the automated data consolidation module 100 of this disclosure couldbe used in other healthcare settings such as the intensive care unit,the emergency room or on the ward. As shown in FIG. 1 , the module 101may be mounted on an IV pole 105 or other suitable mounting structurelocated near the patient 102.

In some examples, a touch-screen electronic record display 126 canconvert to a qwerty-type keyboard to allow uncommon anesthetic andsurgical events or deviations from pre-recorded scripts, to be manuallydocumented. In some examples, natural language speech recognitionsoftware may be included in the processing circuitry 157 allowing theoperator to simply dictate the record. This allows the standard computerkeyboard that is used for data entry in most electronic anestheticrecords, to be eliminated. Standard keyboards are known to becontaminated with pathogenic organisms and are nearly impossible toclean and decontaminate due to their irregular surfaces. In contrast,the smooth glass or plastic face of a touch-screen monitor is easy toclean with no crevasses to hide organisms.

In some examples, the automated data consolidation module for IVmedications 100 of this disclosure can include a system forautomatically measuring and recording the administration of IVmedications. In some examples, the system for automatically measuringand recording the administration of IV medications includes a medicationidentification and measurement system 128. In some examples, aspects ofthe automated data consolidation module 100 can be provided togetherwith or separately from other aspects of the IV medicationidentification and measurement system 128 (hereinafter, “medicationidentification and measurement system 128”). Likewise, aspects of themedication identification and measurement system 128 can be providedtogether with or separately from other aspects of the automated dataconsolidation module 100.

FIG. 2 illustrates an isometric view of an example automated dataconsolidation module 200 for generating an automated electronicanesthetic record located proximate to a patient 202. Features of theautomated data consolidation module 100 of FIG. 1 may be included in theautomated data consolidation module 200 of FIG. 2 , and vice-versa,therefore all aspects may not be described in further detail. Likenumerals can represent like elements. Aspects of FIGS. 1 and 2 may alsobe described together. Some aspects of FIG. 2 , including an IV fluididentification and measurement system 130, are described with respectother figures, including the description of IV fluid identification andmeasurement system 1430 of FIG. 14 .

As shown in FIG. 2 , an example medication identification andmeasurement system 228 may be attached to a relocation module 201 thatmay be advantageously positioned proximate the patient 202, such as nearthe patient's head on a surgical table 212. In this position medicationscan be conveniently administered by medical personnel while also tendingto and observing the patient 202 during surgery.

It would be difficult or even impossible to manage the uncontained wasteheat produced by electronic and electromechanical equipment mounted on asimple open rack because it can escape in any direction. In someexamples, the automated data consolidation module 100, 200 can include acowling (e.g., 299C; FIG. 2 ) covering substantially the entire outersurface of the housing 299. The cowling 299C not only protects theequipment from accidental fluid damage but also confines the waste heatfrom the electronic and electromechanical equipment mounted within theautomated data consolidation module 100, 200 to the inside of the module201 and cowling 299C. In some examples, the confined waste heat can thenbe safely managed.

In some examples, the cowling 299C cover of the automated dataconsolidation module 100, 200 can form or support a waste heatmanagement system. In some examples, the cowling 299C can be provided onan inner surface of the housing 299. In some examples, the cowling 299Ccan be described as an insulation. In some examples, the housing 299 caninclude other types of insulation from heat and/or water. Any suitabletype of insulated housing suitable for use in a surgical field can beprovided.

In some examples, the medication identification and measurement system128 (FIG. 1 ), 228 (FIG. 2 ) may include one or more sensors, such asone or more of: a barcode reader or QR code reader (e.g., 436, FIG. 4 ),a radio-frequency identification (RFID) interrogator (e.g., 438, FIG. 4), or any other suitable sensor for accurately and reliably identifyinga medication for IV administration. As defined herein, a barcode readercan include any other type of identifying reader, such as, but notlimited to, a QR code reader. Likewise, the RFID interrogator can be anytype of interrogator and is not limited to those interrogators based onradio frequency. Examples of such sensors are described herein, such asin FIGS. 4 and 5 .

In some examples, instead of, or in addition to one or more of an RFIDinterrogator 438 and a barcode reader 436, the medication identificationand measurement system 128, 228 can receive an input to determine theidentity. For example, the medication identification and measurementsystem 128, 228 can include one or more of: a sensor, such as barcodereader 436 of FIG. 4 , configured to identify the one or more IVmedications or fluids, or an input configured to receive the identity ofthe one or more IV medications or fluids, such as via the anestheticrecord input component 224.

In some examples, the barcode reader (e.g., 436, FIG. 4 ) may be a“computer vision” or “machine vision” camera with the capability ofreading barcodes. The term “machine vision” is often associated withindustrial applications of a computer's ability to see, while the term“computer vision” is often used to describe any type of technology inwhich a computer is tasked with digitizing an image, processing the datait contains and taking some kind of action. In this disclosure the terms“machine vision” and “computer vision” may be used interchangeably.Traditionally, machine vision includes technology and methods used toprovide imaging-based automatic inspection and analysis, processcontrol, and robot guidance. Machine vision is sometimes used inmanufacturing environments. Machine vision refers to many technologies,software and hardware products including processing circuitry,integrated systems and methods.

The inventors have discovered that machine vision can be useful beyondits traditional uses. The inventors discovered that machine vision canbe advantageous in implementing an automated data consolidation module100, 200 because it offers reliable measurements, gauging, objectrecognition, pattern recognition and liquid fill level measurements.Machine vision does not get tired or distracted. Machine vision excelsat quantitative measurement of a structured scene because of its speed,accuracy and repeatability. However, it may require the scene to bestructured to perform the desired function.

Machine vision can be very accurate for measuring size of an object at aknown distance or the distance of an object of known size. However, itcannot do both. Therefore, in some examples it is important to know theexact location of a syringe (e.g., 406, FIG. 4 ) and thus know thedistance from the camera (e.g., 436, FIG. 4 ) to the syringe (e.g., 406,FIG. 4 ) in order for the machine vision to calculate the distance ofthe movement of the plunger (e.g., 446, FIG. 5 ) within the syringe(e.g., 406, FIG. 5 ). This is what we mean by the “scene beingstructured.”

Machine vision may be advantageous for the automated data consolidationmodule 100, 200 of this disclosure because it “sees” and measures, butdoes not touch or interfere with the healthcare provider doing theirnormal job of injecting medications or administering IV fluids. Further,the same visual image that is used by the machine vision software can betransmitted and displayed on a screen 126, 226 to give the operator(whose fingers can be pushing the plunger 446 of the syringe 406, aclose-up view of the syringe 406. FIG. 5 is a cross-section view takenat 5-5 of FIG. 4 . The machine vision camera 436 can be looking at thesame view of the syringe 406 as the operator and it is the same orsimilar view that the operator would see if they were injecting IVmedications the traditional way.

The machine vision camera, or digital camera, can include machine visionsoftware, or the machine vision camera can be in electricalcommunication with (e.g., operably coupled to) one or more hardwareprocessors, such as processing circuitry 157, 257 and one or moremachine-readable mediums 159, 259. The one or more machine-readablemediums 159, 259 can include instructions (e.g., software), that whenimplemented on the processing circuitry 157, 257, can perform thefunctions described herein. The processing circuitry 157, 257 can bestored in the module 101, relocation module 201 or remote from themodules 101, 201 (e.g. in a wired or wireless manner). The one or moremachine-readable mediums 159 can be a storage device, such as a memorylocated in the module 201 or remote from the module 101, 201.

In some examples, the RFID interrogator 438 may be either High Frequency(HF) or Near Field (NF) RFID in order to advantageously limit theread-range to a distance of less than 12 inches. In some examples, theRFID read-range may advantageously be limited, such as to less than 8inches so that only a specific medication injection is identified at anytime. In a possibly more preferred example, the RFID read-range may belimited to less than 4 inches to further prevent ads-readings. NF-RFIDhas a short read-range by definition and the read-range of HF-RFID canbe easily limited by restricting the size of the antenna on the tag. Incontrast, longer read-range RFID such as Ultra-high Frequency (UHF-RFID)may confusingly interrogate every RFID tag in the operating room andthus be unable to identify which medication is being delivered to themedication identification and measurement system 128, 228. However, anysuitable RFID range for a particular application may be used.

FIG. 3 illustrates a plan view of an example of preloaded syringes 306Aand 306B that can be used with the automated data consolidation module200 of FIG. 2 .

The one or more preloaded syringes 306A and 306B may be labeled with aunique barcode label 307 or an RFID tag 308 that may identify one ormore of the drug, the concentration, the lot number, the expirationdate, the manufacturer and other important information. In someexamples, a unique barcode label 307 may be a “2-D” barcode label inorder to include more information on a smaller area than traditionalbarcode labels. In some examples, the barcode label 307 or RFID tag 308includes the drug identifying label 309A and 309B for convenient use bythe caregiver.

In some examples, the syringes 306A and 306B can be filled at the pointof use and may be labeled with drug labels 309A and 309B and eitherbarcode labels 307 or RFID tags 308 that are removably attached to thedrug bottle or vial at the factory or pharmacy. The drug labels 309A and309B and either barcode labels 307 or RFID tags 308 may be easilyremoved from the drug bottle or vial and adhesively attached to thesyringe 306A or 306B at the time that the syringe 306A or 306B is loadedwith the drug by the caregiver. Instead of, or in addition to thebarcode labels 307 or tags 308, any other suitable “tag/reader” systemknown in the arts, may be used.

FIGS. 4-10 illustrate examples of medication identification andmeasurement systems 428, 628, 828 that can be used with the automateddata consolidation module 100, 200 of FIGS. 1 and 2 . However, aspectsof the medication identification and measurement systems 428, 628 and828 may be used with other systems, and other medication identificationand measurement systems may be used with the automated dataconsolidation module 100, 200. Furthermore, some examples of theautomated data consolidation module 100, 200 can omit aspects of themedication identification and measurement systems, or can omit amedication identification and measurement system altogether. FIG. 4illustrates a portion of an automated data consolidation module 400including a side view of an example medication identification andmeasurement system 428 and a syringe 406 that can be used with theautomated data consolidation module 100, 200 of FIGS. 1 and 2 , tomonitor drug delivery. FIG. 5 illustrates a cross-sectional view of themedication identification and measurement system 428 and the syringe 406(not shown in cross-section) of FIG. 4 , taken along line 5-5. FIGS. 4and 5 are described together.

As shown in FIGS. 4 and 5 , the medication identification andmeasurement system 428 may include at least one injection portal 411.The injection portal 411 may be a receptacle for accommodating a syringe406 in a fixed and known location and can be configured to orient theLuer taper connector 513 to mate with an injection port 515. Theinjection port 515 can be secured within the injection portal 411 andcan be in fluid communication with IV tubing 520. In some examples, theinjection portal 411 may include an injection portal tube 416, such as atransparent tube that is sized to receive and accommodate a syringebarrel 418 of a syringe 406. In some examples, the injection portal canbe configured to receive a specific size syringe barrel 418. In someexamples, multiple injection portals 411 can be provided to accommodatesyringes 406 of different sizes.

FIG. 6 illustrates a portion of an automated data consolidation module600 including a side view of a second example of a medicationidentification and measurement system 628 and a syringe 606 that can beused with the automated data consolidation module 100, 200 of FIGS. 1and 2 , to monitor drug delivery. FIG. 7 illustrates a cross-sectionalview of the second example of a medication identification andmeasurement system 628 and the syringe 606 (not shown in cross-section)of FIG. 6 , taken along line 7-7. FIGS. 6 and 7 are described together.

As shown in FIGS. 6 and 7 , the injection portal 611 of the medicationidentification and measurement system 628 may be large enough toaccommodate syringes 606 of multiple sizes within the space defined by areal or imaginary injection portal tube 616. In this example, accuratelyorienting the Luer taper connector 713 to mate with an injection port715 may be accomplished by one or more orienting members such as one ormore spring positioning members 622A-F that engage with the syringebarrel 618 to center it in the injection portal 611. In some examples,there may be two or more rows of spring positioning members 622A-F. Forexample, spring positioning members 622A, B, E, F may be located nearthe entrance to the injection portal 611 and spring positioning members622C, D may be located near the injection port 715 to assure accuratepositioning for mating with the Luer taper connector 713. Springpositioning members 622A-F may include not only spring wires or metal orpolymer or plastic spring pieces but any flexible material orcombination of materials or shapes that can be deformed by the syringebarrel 618 entering the injection portal 611 and retain a memory (e.g.,elastically deformable, substantially elastically deformable,resiliently deformable, resilient member) so as to urge the syringebarrel 618 into a centered position within the space defined by a realor imaginary injection portal tube 616.

One objective of the spring positioning members 622A-F can be to“automatically” center and align the Luer taper connector 713 of thesyringe 606 with the injection port 715, so that the operator can simplyand conveniently push the syringe 606 into the injection portal 611 andno further manual alignment may be needed. The spring positioningmembers 622A-F can also obviate the need for the operator to toucheither the Luer taper connector 713 of the syringe 606 or the injectionport 715, thus beneficially preventing accidental infectiouscontamination by the operators' fingers and gloves.

FIG. 8 illustrates a portion of an automated data consolidation module800 including a side view of a third example of a medicationidentification and measurement system 828 and a syringe 806 that can beused with the automated data consolidation module 100, 200 of FIGS. 1and 2 . FIG. 9 illustrates a cross-sectional view of the third exampleof a medication identification and measurement system 828 and thesyringe 806 (not shown in cross-section) of FIG. 8 , taken along line9-9. FIGS. 8 and 9 are described together.

As shown in FIGS. 8 and 9 , a syringe barrel 818 may be centered andheld in place by one or more orienting members, such as compressionpositioning members 842A,B. The compression positioning members 842A, Bmay be urged apart by inserting the syringe barrel 818 there between.Springs 844A-D can compress and create a pressure pushing thecompression positioning members 842A,B against syringe barrel 818. Thecompression positioning members 842A,B shown in FIGS. 8 and 9 are merelyillustrative, and many other sizes, shapes, numbers and locations ofcompression positioning members 842 are anticipated.

Compression positioning members 842A,B may be simple spring 844A-Dactivated devices (e.g., resilient members) as shown in FIGS. 8 and 9 ormay be any mechanism that can expand (e.g., resiliently expand) toaccommodate syringe barrels of various sizes and urge the syringe barrel818 into a centered position within the space defined by a real orimaginary injection portal tube 816. This example shows spring 844A-Dactivated compression positioning members 842A,B but many othermechanical activation mechanisms are anticipated. The compressionpositioning members 842A,B can be elastically deformable, substantiallyelastically deformable, resiliently deformable, include one or moreresilient members.

Other examples of positioning members designed to hold an insertedsyringe 806 in the center of the injection portal 811 and thus orientingthe Luer taper 913 for mating with the injection port 915 areanticipated. Positioning the inserted syringe 806 in the center of theinjection portal 811 allows the machine vision to work from a knowndistance and thus calculations of syringe plunger 948 movement can bevery accurate.

In some examples, instead of the positioning members shown in theexamples of FIGS. 6-9 holding a syringe centrally, the positioningmembers 622A-F or 842A,B can be designed to hold an inserted syringe606, 806 at a known, but off center position in the injection portal611, 811, such as when the injection port 715, 915 (FIGS. 7 and 9 ) ispositioned off center in the injection portal 611, 811. Any arrangementof at least one positioning member that aligns an inserted syringe at aknown position may be provided.

In some examples, and as shown in FIGS. 4, 6 and 8 the medicationidentification and measurement system 428, 628, 828 of this disclosuremay include one or more “machine vision” cameras 436, 636, 836 thatinput digital images into one or more processors having processingcircuitry 157, 257 as shown and described in FIGS. 1, 2 , that isprogramed to analyze machine vision images. In some examples, one of theimages that the machine vision cameras 436, 636, 836 may “see” is abarcode label 307 on the syringe 406, 606, 806, that has been insertedinto the injection portal 411, 611, 811, for identifying the medicationin the syringe 406, 606, 806. As previously noted, the barcode label 307can identify the brand name and/or generic name of the medication in thesyringe. In some examples, the barcode label 307 also may identify oneor more of the concentration of the medication, the lot number, theexpiration date and other information that may be useful for inventorymanagement.

As shown in FIGS. 4, 6 and 8 , the automated data consolidation module400, 600, 800 of this disclosure can include one or more radio frequencyidentification (RFID) interrogation antennas 438, 638, 838 that inputRFID information into a processor, such as processing circuitry 157, 257as shown and described in FIGS. 1 and 2 , that is programed to analyzeRFID data. In some examples, the RFID interrogation antennas 438, 638,838 can interrogate a RFID tag 308 (FIG. 3 ) attached to the syringe406, 606, 806, that has been inserted into the injection portal 411, 611811, for identifying the medication in the syringe 406, 606, 806. Insome examples, short range RFID such as near field (NF) or highfrequency (HF) may be advantageous because they may only detect thesyringe 406, 606, 806 that is adjacent to or inside the security systemfor IV medications 400, 600, 800, and not detect the various othermedication syringes that may be sitting on the worktable such as206A-206C in FIG. 2 .

As shown in FIGS. 4, 6 and 8 the medication identification andmeasurement system 428, 628, 828 of this disclosure may include a RFIDinterrogator 438, 638, 838. In some examples, the RFID interrogator 438,638, 838 that can include antennas that may be located inside themedication identification and measurement system 428, 628, 828 . In someexamples, the RFID interrogator antennas 438, 638, 838 may be locatedexternal to but proximate the medication identification and measurementsystem 428, 628, 828. As the syringe 406, 606, 806 is brought intoproximity of the medication identification and measurement system, theRFID interrogator 438, 638, 838 can interrogate the RFID tag 308 on thesyringe 406, 606, 806, thereby accurately and reliably identifying amedication for IV administration. In some examples, the RFID tag 308 orother marker may include one or more of: the generic and brand name ofthe drug, the concentration, the lot number, the expiration date, themanufacturer and other important information that may be recorded. Insome examples, the generic and brand name of the drug and theconcentration of the drug can be displayed in the injection section of adisplay such as the display 126, 226 (FIGS. 1, 2 ).

Machine vision is very accurate for measuring the size of an object at aknown distance or the distance of an object of known size. However, itcannot do both. Therefore, in some examples it is important to know theexact location of a syringe and thus know the distance from the camerato the syringe in order to accurately calculate the distance of themovement of the plunger within the syringe.

Syringes are available in multiple sizes such as 3 cc, 6 cc and 12 cc,each of which is a different diameter. The machine vision processor mustknow both the internal diameter of the barrel of the syringe and thedistance that the syringe plunger moves down the barrel, in order tocalculate the volume of medication injected, unless it has anothersource of information. The machine vision of this disclosure can measurethe diameter of the syringe because in the examples the syringe 406,606, 806 is held at known distance and in a centered location relativeto the machine vision cameras 436, 636, 836. Alternately, the automateddata consolidation module 400, 600, 800 of this disclosure may beprogramed to know that the particular hospital uses only Monoject®syringes for example and the internal diameter of each Monoject® syringesize may be pre-programed into the computer. In this case, the machinevision only needs to differentiate 3 cc, 6 cc and 12 cc syringe sizesfrom each other. The machine vision processor can determine the internaldiameter of the barrel of the syringe. In some examples, the syringesize may be included in the information provided by the barcode 307 orRFID 308 (FIG. 3 ).

In some examples, such as the examples of FIGS. 4-9 , the machine visionsystem, including the machine vision camera 436, 636, 836 and theprocessor 157, 257 of FIGS. 1 and 2 (e.g., processing circuitry) inelectrical communication with the machine vision camera 436, 636, 836,can visually detect and determine other geometry information about thesyringe 406, 606, 806 besides the outside diameter, such as determiningthe inside diameter, or the inner or outer length of the syringe. Themedication identification and measurement systems 428, 628, 828 can usethe geometry information to determine the size or type of the syringe406, 606, 806, or can use the geometry information to calculate a volumeof the syringe 406, 606, 806.

In some examples, as the syringe 406, 606, 806 is advanced into theinjection portal 411, 611, 811, the image of the syringe 406, 606, 806entering the injection portal 411, 611, 811 is displayed in real time inan injection section 126 a, 226 a of the display 126, 226 (FIGS. 1 and 2). Therefore, the caregiver can watch the syringe 406, 606, 806 advanceand engage with the injection port 515, 715, 915. In some examples, theinjection portal tube 416, 616, 816 or the spring positioning members622A-E or the compression positioning members 842A,B, urge the syringe606, 806 into position to mate with the injection port 715, 915 but theactual connection can also be observed as it is happening by thecaregiver on the display 126, 226. Even though the caregiver is notphysically holding the injection port 515, 715, 915 as they typicallywould, they can watch the engagement of the Luer connector 513, 713, 913with the injection port 515, 715, 915 on a display 126, 226, the view isessentially identical to the thousands of injections that they have madeduring their career. In some examples, the actual image of the syringe406, 606, 806 can be displayed on the display 126, 226, while in otherexamples the data obtained by the camera 436, 636, 836 can be convertedto a representation of the syringe displayed on the display 126, 226.

In some examples, once the syringe 406, 606, 806 is securely connectedto the injection port 515, 715, 915, the caregiver pushes on the plunger446, 646, 846 of the syringe 406, 606, 806, injecting the medicationinto the injection port 515, 715, 915 and IV tubing 520, 720, 920. Thecaregiver can visualize the plunger seal 548, 748, 948 move down thesyringe barrel 418, 618, 818 and can determine the volume of medicationinjected by the graduated markings on the syringe 406, 606, 806. Thus,the engagement of the Luer connector 513, 713, 913 with the injectionport 515, 715, 915 and the injected volume are observed by the caregiveron the display 126, 226 and the traditional method and routine ofinjection is minimally altered by implementing the automated dataconsolidation module 100, 200 including the example medicationidentification and measurement systems 428, 628, 828.

In some examples, the processing circuitry 157, 257 (FIGS. 1 and 2 ) ora computer may also simultaneously generate data representing a runningtotal of the volume and dosage of the injected medication and cantransmit the generated data to the display 126, 226 to display volumeand dosage information on the display 126, 226. In some examples, theprocessing circuitry 157, 257 or a computer may also generate its owngraduated scale and transmit the generated graduated scale informationto the display 126, 226 to superimpose the scale on the image of thesyringe 406, 606, 806 or next to the image of the syringe 406, 606, 806,for added visual clarity of the injected volume and dose.

In some examples, the machine vision determination of the injectedvolume may be calculated by multiplying the internal cross-sectionalarea of the syringe (πr²) by the distance that the syringe plungermoves. The radius of the syringe may be determined in one or more ways.For example, the machine vision function may determine that the syringeapproximates a 3 cc or 12 cc syringe and the computer is programed toknow that the hospital uses a specific brand of syringes and theinternal diameter (radius) of each of these syringe sizes is preciselyknown. (An example of diameter d, radius r is shown in FIG. 5 ) Anotherexample may require the machine vision camera to measure the outerdiameter of the syringe and then subtract an approximated wall thickness(either measured or known value stored in a memory) from the measureddiameter to determine the internal diameter. In another example, theinternal diameter of the syringe may be supplied to the processingcircuitry 157, 257 or a computer as part of the RFID 308 or barcode 307information. In another example, the machine vision may determine theinner diameter of the syringe by determining an outer diameter of theplunger as viewed through the transparent or semi-transparent syringeand determine the wall thickness. In yet another example, the machinevision may be able to visibly determine the inner diameter or radiusdirectly through the transparent or semi-transparent syringe. Any othersuitable determination, calculation or algorithm may be used todetermine the radius, diameter and injected volume.

In some examples, the machine vision determination of the distance thatthe syringe plunger 446, 646, 846 moves may be by “observing” themovement of the black rubber plunger seal 548, 748, 948 against thevisible scale printed on the syringe 406, 606, 806. In this example, themachine vision can be programed to recognize the markings on the syringe406, 606, 806.

In some examples, the machine vision determination of the distance thatthe syringe plunger 446, 646, 846 moves may be by observing the movementof the black rubber plunger seal 548, 748, 948 relative to a scalecalculated by the processing circuitry 157, 257 (FIGS. 1 and 2 ). Thegeometrical calculation of the scale that determines the distance thatthe syringe plunger 446, 646, 846 moves may be easiest to determinealong the widest part of the syringe that corresponds with the center C(FIG. 5 ) of the syringe 406, 606, 806, which is a known distance fromthe machine vision camera 436, 636, 836. Alternatively, thecomputer-constructed scale may be applied to the side of the syringe406, 606, 806 facing the camera 436, 636, 836, if the radius of thesyringe 406, 606, 806 is subtracted from the known distance to thecenter C (FIG. 5 ) of the syringe 406, 606, 806 in order to calculatethe distance 437 from the machine vision camera 436, 636, 836 to thenear side (e.g., 411A) of the syringe 406, 606, 806.

In some examples, the movement of the black rubber plunger seal 548,748, 948 of the syringe 406, 606, 806 can be clearly identifiable by themachine vision camera 436, 636, 836 and a scale to determine thedistance moved by the plunger 446, 646, 846 can either be “visualized”or constructed by the machine vision computer (e.g., processingcircuitry). Multiplying the distance that the plunger seal 548, 748, 948moves by the known or measured internal diameter d (FIG. 5 ) of thesyringe 406, 606, 806 and thus cross-sectional area of the plunger seal548, 748, 948, allows the processing circuitry 157, 257 or a computer inelectrical communication with the processing circuitry 157, 257 tocalculate an accurate injected volume. The measured injection volume anddosage may be displayed on the display 126, 226 of the module 101, 201(FIGS. 1 and 2 ). Without interfering with or changing theanesthesiologists' normal or traditional medication injection routines,an unobtrusive machine vision camera 436, 636, 836 and computer (e.g.,processing circuitry) can “observe” the medication injections andautomatically record them in the EMR.

In some examples, the injected volume of medication may be determined byother sensors or methods. For example, the systems described herein canemploy (e.g., substitute) other sensors such as a non-visual opticalsensor 436A in place of or in addition to the machine vision camera 436,636, 638 described in FIGS. 4-9 . For example, a light source can shineon one or more light sensitive elements such as photodiodes, and theposition of the plunger of the syringe can be roughly determined by theobstruction of the light beam by the plunger. Other fluid measurementmethods can have a sensor including adding magnetic material to thesyringe plunger and detecting movement of the plunger with a magneticproximity sensor. Alternatively, fluid flow may be measured with fluidflow meters in the IV fluid stream. These examples are not meant to bean exhaustive list but rather to illustrate that there are alternativetechnologies to machine vision (e.g., sensors), for noncontactmeasurement (e.g., sensing) of fluid flow from a syringe that areanticipated in this disclosure.

In some examples, the injected volume of medication may be determined byother sensors or methods. For example, the systems described herein canemploy (e.g., substitute) other sensors in place of or in addition tothe machine vision cameras for either or both the medication and fluidflows. Other fluid flow sensors anticipated by this disclosure includebut are not limited to: ultrasonic flow meters, propeller flow meters,magnetic flow meters, turbine flow meters, differential pressure flowmeters, piston flow meters, helical flow meters, vortex flow meters,vane flow meters, paddle wheel flow meters, thermal flow meters,semicylindrical capacitive sensor flow meters and Coriolis flow meters.

Securing the injection port 515, 715, 915 within the injection portal411, 611, 811 prevents the caregiver from touching the injection port515, 715, 915. Normally caregivers wear gloves to protect themselvesfrom infectious contaminates from the patient and operating room andtheir gloves are nearly always contaminated. Anything they touch will becontaminated. They typically pick up and hold the IV injection port 515,715, 915 with one hand while inserting the Luer taper connector 513,713, 913 of the syringe 406, 606, 806 into the injection port 515, 715,915. In the process, the injection port 515, 715, 915 is frequentlycontaminated with pathogenic organisms from their gloves that can enterthe patient's blood stream with the next injection, causing seriousinfections. It is therefore advantageous from the infection preventionpoint of view, if the Luer connection and injection can be accomplishedwhile never touching the injection port 515, 715, 915.

In some examples as shown in FIGS. 1 and 2 , the automated dataconsolidation module 100, 200 may include an external reader, such asbarcode reader 180, 280 on the module 101, 201 to read a barcode, QRcode or the like for identification. This barcode reader 180, 280 may beused to identify the healthcare provider injecting a medication byreading a barcode or QR code 1186 on the user's ID badge for example(FIG. 11 ). In some examples as shown in FIGS. 1 and 2 , the automateddata consolidation module 100, 200 may include an external RFID reader182, 282 on the module 101, 201. This RFID reader 182, 282 may be usedto identify the healthcare provider injecting a medication by reading anRFID tag 1188 on the user's ID badge 1184B for example (FIG. 11 ). Insome examples as shown in FIGS. 4, 6 and 8 , the automated dataconsolidation module 400, 600, 800 may include an internal RFID reader438, 638, 838 in the module 101, 201. This RFID reader 438, 638, 838 mayalso be used to identify the healthcare provider injecting a medicationby reading an RFID tag on the user's ID badge for example.

It is an important part of the record to know who injected themedication and their identity can be easily verified and documented bythe automated data consolidation module 400, 600, 800 using eitherbarcode, QR code or RFID. Other identification technologies are alsoanticipated.

FIG. 10 illustrates an example injection port cassette 1054 that can beused with the automated data consolidation module 100, 200 of FIGS. 1and 2 , as detailed in FIGS. 5, 7 and 9 . As shown in FIG. 10 , theinjection port 1015 may be mounted on an injection port cassette 1054 inorder to make the attachment to the automated data consolidation module100, 200, 400, 600, 800 easier and more secure. The injection portcassette 1054 may be a piece of molded polymer or plastic onto which theinjection port 1015 and IV tubing 1020 may be attached. The injectionport cassette 1054 may be shaped and sized to fit into a slot in theautomated data consolidation module 100, 200, 400, 600, 800. When theinjection port cassette 1054 is fit into a slot in the automated dataconsolidation module 100, 200, 400, 600, 800, the injection port 1015can be positioned substantially in the center of the injection portal411, 611, 811 for mating with the Luer tapers 513, 713, 913. Theinjection port cassette 1054 can also be configured to be removed intactfrom the automated data consolidation module 400, 600, 800 so that thepatient can be transferred and the IV tubing 1020 can be moved with thepatient and continue to operate normally.

In some examples, and as shown in FIG. 10 , the injection port cassette1054 can include an IV bypass channel 1056 in the IV tubing 1020. The IVbypass channel 1056 can allow the IV fluids to flow unencumbered by themedication injection apparatus. The injection port cassette 1054 caninclude a medication channel 1058 in the IV tubing 1020 and, themedication channel 1058 may include one or more stop-flow clamps1060A,B. The one or more stop-flow clamps 1060A,B may be activated bythe automated data consolidation module 100, 200, 400, 600, 800 if amedication error is identified. The one or more stop-flow clamps 1060A,Bmay be powered by one or more electromechanical solenoids that squeezethe IV tubing in the medication channel 1058 flat, obstructing the flow.Other electromechanical flow obstructers are anticipated.

In some situations, such as when administering a drug to a patientallergic to that drug, or administering potent cardiovascular drugs to apatient with normal vital signs, or administering a drug with a likelymistaken identity, the computer, such as processing circuitry 157, 257(FIGS. 1 and 2 ) for the automated data consolidation module 100, 200,400, 600, 800 of this disclosure can automatically activate thestop-flow clamps 1060A,B to compress the medication channel 1058 tubingupstream and/or downstream from the injection port 1015. Compressing theIV tubing both upstream and downstream from the injection port 1015prevents the injection of any medication into the IV tubing 1020. Analert to the adverse condition of the injection may be displayed ondisplay 126, 226 where the stop-flow condition can be over-ridden by theoperator touching a manual override switch on the display 126, 226 orthe module 101, 201, if the injection was not erroneous. While thestop-flow can occur in the medication channel 1058, the IV fluid flowcan continue normally in the parallel bypass channel 1056.

The stop-flow clamps 1060A,B can allow the processing circuitry 157, 257(e.g., processor, hardware processing circuitry) of the automated dataconsolidation module 100, 200, 400, 600, 800 to not only warn theoperator of a pending medication error, but physically prevent theinjection. Perhaps equally as important is that the stop-flow clamps1060A,B can be quickly released by the operator touching a manualoverride switch in the event that the apparent error was in fact aplanned event or otherwise desired by the operator.

In some examples, a part of the automated data consolidation module 100,200, 400, 600, 800 can include the ability for the computer (e.g.,machine) to know the patient's medical history, medication orders, vitalsigns, current medications, medication orders and other importantinformation about that patient. In some examples, the medication insyringe 306 can be identified by RFID tag 308 (FIG. 3 ) and is detectedby RFID interrogator 438, 638, 838 as the syringe 306 enters injectionportal 411, 611, 811. The processing circuitry (e.g., 157, 257) of theautomated data consolidation module 100, 200, 400, 600, 800 cancross-reference the proposed injection to the patient's medical history,medication orders, vital signs, current medications and other importantinformation about that patient, providing a safety “over-watch” guardingagainst medication errors. In some examples, the processing circuitry(e.g., 157, 257) of the automated data consolidation module 100, 200,400, 600, 800 may include algorithms and/or “artificial intelligence”that can provide alternative medication suggestions based on patient'smedical history, medication orders, vital signs, current medications andother important information about that patient.

In some examples, the EMRs that were created by the automated dataconsolidation module 100, 200, 400, 600, 800 of this disclosure canprovide accurate and temporally correlated information about therelationship between any injected medication and the resultingphysiologic response. This is uniquely accurate dose-response data. Insome examples, the EMRs that were created by the automated dataconsolidation module 100, 200, 400, 600, 800 for hundreds of thousandsor even millions of patients, may be aggregated and analyzed as “bigdata.” The “big data” from these EMRs may be used for a variety ofpurposes including but not limited to medical research, patient andhospital management and the development of “artificial intelligence”algorithms that can provide alternative medication suggestions. Ongoing“big data” from more and more EMRs can be used to continually improveand refine the “artificial intelligence” algorithms, much like the“artificial intelligence” algorithm development process being used todevelop self-driving vehicles. These “artificial intelligence”algorithms can be used to provide automated (“self-driving” or“partially self-driving”) anesthesia during surgery or automatedmedication delivery.

FIG. 11 illustrates a plan view of an example of healthcare provider IDbadges 1184A and 1184B that can be used with the system of FIGS. 1 and 2, in accordance with at least one example. In some examples, the “chainof custody” may begin by electronically identifying the healthcareprovider as the drugs are checked out from the pharmacy or Pixismedication dispenser. In some examples and as shown in FIG. 11 , eachprovider can have a personalized RFID tag 1186, attached to theirhospital ID badge 1184A. In some examples each provider can have apersonalized barcode 1188, attached to their hospital ID badge 1184B forexample. When the drugs are checked out, the personalized RFID tag 1186may be read by an RFID interrogator or the personalized barcode 1188read by a barcode reader in the pharmacy and the ID of the providerchecking the drugs out may be noted in the hospital's computer and/orthe processing circuitry 157, 257 (FIGS. 1 and 2 ) for the automateddata consolidation module 100, 200, 400, 600, 800 (FIGS. 1, 2, 4, 6 and8 ). The specific RFID 308 or barcode 307 (FIG. 3 ) identification ofthe injectable drug may also be recorded before the drug leaves thepharmacy and that information may be transmitted to the processingcircuitry 157, 257 of the automated data consolidation module 100, 200,400, 600, 800 of this disclosure. In some examples, instead of an RFIDtag 1186 and RFID reader, other provider identification information andsensors for identifying the provider can be used, such provideridentification information may include: a barcode, a QR code with thesensor being able to read such codes. In other examples, the sensor caninclude a retinal scanner, fingerprint reader or a facial recognitionscanner that identifies the provider by personably identifiableinformation (e.g., provider identification information) may be used.

In some examples, when the provider arrives at the patient's bedside,the provider may be identified by their ID badge 1184A,B. In someexamples, an ID badge 1184A that has an RFID tag 1186 may be read byRFID reader 182, 282 (FIGS. 1 and 2 ) that can be located on theautomated data consolidation module 100, 200, 400, 600, 800 or by RFIDreader 438, 638, 838 (FIGS. 4, 6 and 8 ) located inside the automateddata consolidation module 100, 200, 400, 600, 800 (FIGS. 1, 2, 4, 6 and8 ). In some examples, an ID badge 1184B that has a barcode 1188 may beread by barcode reader 180, 280 that can be located on the automateddata consolidation module 100, 200, 400, 600, 800. In some examples, aretinal scanner may be located on or near module 101, 201 in order topositively identify the provider by their retinal vasculature. Otherscanners including but not limited to facial recognition scanning arealso anticipated in order to positively identify the provider doing theinjection in order to automatically document this information to an EMRor other record.

In some examples, the provider's photograph may be taken by camera 190,290 (FIGS. 1 and 2 ) for further identification before allowing theinjection of scheduled drugs. In some examples, the camera 190, 290 maybe triggered, such as by processor 157, 257 (FIGS. 1 and 2 ), when asyringe e.g., 306B filled with a scheduled drug such as a narcotic isidentified as it enters the injection portal 411, 611, 811 and the RFIDinterrogator 438, 638, 838 interrogates the RFID tag 308 (FIG. 3 ) orthe machine vision camera 436, 636, 836 reads the barcode 307 (FIG. 3 )on the syringe 306A. Non-scheduled medications may not need the addedsecurity of a photograph.

In some examples as shown in FIGS. 1 and 2 , the automated dataconsolidation module 100, 200 of this disclosure may include a remotemonitor with display 187, 287. The remote monitor may include a wired orwireless connection to the automated data consolidation module 100, 200and may display some or all of the information shown on the electronicrecord display 126, 226, or other information generated by the automateddata consolidation module 100. For example, the processing circuitry157, 257 can be in electrical communication with the remote display 187,287 and the processing circuitry 157, 257 can send instructions to theremote display 187, 287 to display the generated information.

The remote monitor may be in the next room or miles away. The remotemonitor may allow remote supervision of healthcare delivery. Forexample, anesthesiologists frequently supervise up to four surgicalanesthetics at once, each being delivered by a nurse anesthetist. Inthis case, the anesthesiologist carrying a wireless remote monitor 187,287 can have real-time data on each case under their supervision.Similarly, a nurse anesthetist working in a rural hospital may besupervised by an anesthesiologist who is 50 miles away.

In some examples, the remote monitor with display 187, 287 can create arecord for billing. For example, when an anesthesiologist is supervisingmultiple anesthetics at once, the payers may dispute the involvement ineach case and refuse to pay. The remote monitor with display 187, 287may include an RFID reader that documents the close proximity of an RFIDtag on the anesthesiologist's ID badge. Any other type of proximitysensor may be used in place of the RFID tag, including but not limitedto GPS location sensing. Documenting that the anesthesiologist wascarrying the remote monitor with display 187, 287 throughout the time ofthe surgery is very good evidence that the anesthesiologist was activelyparticipating in the care of the patient.

In some examples, the remote monitor with display 187, 287 allowslong-distance medical consultation. For example, an expert at the MayoClinic could consult with a physician halfway around the world in Dubai,responding to real-time patient data displayed on the remote monitorwith display 187, 287.

FIG. 14 illustrates a side view of an example IV fluid identificationand measurement system 1430 that can be used with the systems of FIG.1-9 , and the injection port cassette of FIG. 10 . Some aspects of FIGS.1-14 are described together, however, the examples are merelyillustrative and the features can be used in any suitable combination.In some examples, the automated data consolidation module 100, 200 ofthis disclosure includes a system for automatically measuring andrecording the administration of IV fluids. To accomplish this, as shownin FIGS. 1, 2 and 14 , the automated data consolidation module 100, 200can include an IV fluid identification and measurement system 130, 230,1430. In some examples, the IV fluid identification and measurementsystem 130, 230, 1430 can be mounted onto module 101.

Alternately, the IV fluid identification and measurement system 130,230, 1430 may be mounted to an IV pole 105 or racking system independentfrom the module 101. The system for automatically measuring andrecording the administration of IV fluids is not limited to use inanesthesia or in the operating room, but has applicability for usethroughout the hospital and other health care settings, including butnot limited to the ICU, ER, wards, rehabilitation centers and long termcare settings. In some examples, aspects of the IV fluid identificationmeasurement system 130, 230, 1430 can be provided alone or together withother features of the automated data consolidation module 100, 200including the medication identification and measurement system 128, 228.

In some examples, the IV fluid identification and measurement system130, 230, 1430 may be configured to accommodate one or more bags of IVfluid 132, 232A,B and 1432A,B. Each bag of IV fluid can include a dripchamber 134, 234A,B and 1434A,B and IV tubing 120, 220A,B and 1420A,B.IV flow rates may be controlled with the traditional manually operatedroller clamp that variably pinches the IV tubing 120, 220A,B and 1420A,Bto control or even stop the flow of IV fluids. In some examples, IV flowrates may be controlled with the automatically operatedelectromechanical flow rate clamps 1478 that variably pinch the IVtubing 1420A to control or even stop the flow of IV fluids. Theautomatically operated electromechanical flow rate clamps 1478 may becontrolled by the processing circuitry 157, 257, such as an electronicanesthetic record computer in module 101 or by any other suitableprocessor including hardware processing circuitry that is in electricalcommunication with the IV fluid identification and measurement system130, 230, 1430 and/or is located within the IV fluid identification andmeasurement system 130, 230, 1430.

In some examples, the IV fluid identification and measurement system130, 230, 1430 is configured to automatically measure and record theadministration of IV medications and fluids. The system 130, 230 caninclude one or more of a barcode reader and an RFID interrogator (suchas 1436A,B) for accurately and automatically identifying a fluid for IVadministration. Because of the close proximity to the adjacent bags,barcode identification may be preferable in order to prevent an RFIDinterrogator from reading the RFID tag on a neighboring bag. In someexamples, as shown in FIG. 14 , one or more barcode labels 1405A,B maybe applied to the IV bags 1432A,B in a location where they can be readby a sensor such as a barcode reader or machine vision camera 1436A,B,or another machine vision camera located in a suitable position to readthe barcode. In some examples, a dedicated barcode reader or a machinevision camera may be positioned adjacent the barcode label 1405A,Blocation, specifically for reading the barcode label 1405A,B.

In some examples, the drip chamber 234A,B and 1434A,B of the IV set canbe positioned adjacent the one or more machine vision cameras 1436A,B.In some examples, a standard background 1468A,B may be positioned on theopposite side of the drip chamber 1434A,B from the machine visioncameras 1436A,B. The standard background 1468A,B may be a plainbackground or may be an advantageous color, pattern, color design orillumination that highlights each of the falling drops, for easieridentification by the processing circuitry 157, 257 (e.g., 1502, FIG. 15). The machine vision software including instructions can be stored onone or more machine-readable mediums (such as 1522 in FIG. 15 ) thatwhen implemented on hardware processing circuitry (including but notlimited to processing circuitry 157, 257) or in electrical communicationwith the system, can perform the functions described herein. An exampleof such electrical connection is shown by the connection of processor1502 with mass storage 1516 in FIG. 15 .

In some examples, the processing circuitry 157, 257, 1502 can beconfigured to look for (e.g., sense, monitor, detect) a fluid meniscus1464A,B in the drip chamber 1434A,B. In this case “seeing” a fluidmeniscus 1464A,B indicates that there is fluid in the drip chamber1434A,B and therefore the IV bag 1432A,B is not empty, and air is notinadvertently entering the IV tubing 1420A, 1420B.

In some examples, if the IV fluid identification and measurement system130, 230, 1430 fails to “see” a fluid meniscus 1464A,B meaning that thedrip chamber 1434A,B is empty and thus the IV bag 1432A,B is empty,stop-flow clamps 1460A,B can be automatically activated. For example,processing circuitry 157, 257 can send an instruction to activate thestop-flow clamps 1460A,B to compress the IV tubing 1420A,B in order toprevent air from entering the IV tubing 1420A,B. In some examples, theempty IV bag 1432A,B condition detected by the processing circuitry 157,257 can cause an alert to be displayed to the caregiver on theanesthetic record display 226, such as by sending an instruction to thedisplay.

The combination of the machine vision camera 1436A,B in electricalcommunication with processing circuitry (e.g., 157, 257, FIGS. 1 and 2 )that executes instructions stored on a machine readable medium can countthe number of drops of fluid per unit of time in a drip chamber 1434A,Bto calculate or to estimate the flow rate of an IV. The size of the dripchamber 1434A,B inlet orifice determines the volume of liquid in eachdrop. The inlet orifices of standard drip chambers are sized to createdrops sizes that result in 10, 12, 15, 20, 45 and 60 drops per ml. Givena particular drop volume (size), 10 drops per ml for example, the system130, 230, 1430 (e.g., via sensors, processing circuitry and machinereadable medium) can count the number of drops falling in a known periodof time and use that data to calculate or to estimate the flow rate. Ifthese estimates were attempted by a human, they may be less accurate athigher flow rates (higher drop counts) because the drops are so fast, itcan be difficult to count the drops. Eventually, at even higher flowrates the individual drops become a solid stream of fluid and the flowrate cannot be visually estimated.

In some examples, the IV fluid identification and measurement system130, 230, 1430 is configured to look for falling drops of fluid 1462A,Bwithin the drip chamber 1434A,B. When drops 1462A,B have beenidentified, the machine vision system (e.g., machine vision camera 1436Aor 1436B operably coupled to processing circuitry 157, 257) may firstmeasure the diameter of the drop 1462A,B to determine which of thestandard drop sizes or volumes it is counting. Most hospitalsstandardize on several infusion set sizes, 10, 20 and 60 drops per ccfor example. Therefore, when these limited choices of infusion setbrands and sizes have been programed into the computer, the machinevision system only needs to differentiate between these choices, whichis much easier than accurately measuring the diameter of the drops.Unlike the human eye, the machine vision can accurately count thefalling drops even at high flow rates to calculate an IV fluid flowrate.

In some examples, the machine vision system, including the machinevision cameras 1436A,B and instructions 1524 (e.g., software) stored ona machine readable medium 1522 and implemented by hardware processingcircuitry 157, 257 does not “see” falling drops 1462A,B. In thissituation, either the fluid is flowing in a steady stream that is notidentifiable or the fluid has stopped flowing. In some examples, thesetwo opposite conditions can be differentiated by inserting a floatingobject 1466A,B (hereinafter, “float”) into the drip chambers 1434A,B. Insome examples, the float 1466A,B may be a ball-shaped float 1466A,B. Insome examples, the float may be patterned or multi-colored to moreeasily identify movement or spinning of the float. In some examples, ifthe machine vision system cannot identify falling drops 1462A,B, it thenlooks to the float 1466A,B for additional information. If the float1466A,B is not moving or spinning, the fluid flow has stopped. If thefloat 1466A,B is moving or spinning and drops cannot be identified, thefluid is flowing in a steady stream and the flow rate cannot be measuredby machine vision. In this situation, the system can determine fluidflow using an alternate method.

In some examples, the IV fluid identification and measurement system130, 230, 1430 may be configured to accommodate one or more bags of IVfluid 132, 232A,B, 1432A,B and each of these IV bags may be hanging froman electronic IV scale 1472A,B (e.g., a weight, a physicalcharacteristic sensor). The electronic IV scale 1472A can measure thecombined weight of the IV bag and fluid 1432A, the drip chamber 1434Aand the IV tubing 1420A. The electronic IV scale 1472B can measure theweight or combined weight of one or more of the IV bag and fluid 1432B,the drip chamber 1434B, the IV tubing 1420B and a pressure infuser 1474.In both of these examples, the electronic IV scale 1472A,B canaccurately measure the change in combined weight that occurs due to thedrainage of the IV fluid from the IV bag 1432A,B. The change in weightper unit time can be converted to flow rates by processing circuitry157, 257 in electrical communication with the electronic IV scale 1472A,1472B, for example, by the processing circuitry 157, 257, 1502 anddisplayed on the electronic record display 126, 226.

In some examples, the calculated flow rates for each IV bag 1432A,B mayalso be displayed on one or more digital flow-rate displays 1476A,Bmounted on the IV fluid identification and measurement system 1430. Thedigital flow-rate displays 1476A,B may be small LED or LCD displays thatconveniently tell the operator the flow rate while they are manuallyadjusting the flow rate near the IV bags 1432A,B and drip chambers1434A,B. The digital flow-rate displays 1476A,B are particularlyconvenient when the IV fluid identification and measurement system 130,1430 is a free standing entity mounted on an IV pole 105 for examplewhile being used on the ward or ICU.

In some examples, when the falling drops 1462A,B cannot be detected andyet the floats 1466A,B are moving or spinning, the fluid is determinedto be flowing in a steady stream and the flow rate cannot be measured bymachine vision. In this case the electronic record computer mayautomatically query the change in weight per unit time as measured bythe electronic IV scale 1472A,B to determine the IV flow rate. At highflow rates, the change in weight per unit time as measured by theelectronic IV scale 1472A, B will most likely be more accurate thancounting drops, in determining the IV flow rate.

The IV flow rate as determined by the change in weight per unit time canalso be compared to the IV flow rates determined by counting drops toverify the accuracy of each method. Without interfering with or changingthe healthcare providers normal or traditional IV routines, anunobtrusive machine vision camera and computer can “observe” the IV flowrates and automatically record them in the EMR.

The module or automated EMR system 101, 201 of this disclosure maycapture anesthetic event data but it must be noted that the sametechnologies described herein for capturing anesthetic event data can beused throughout the hospital or outpatient health care system to captureand record medication administration, IV fluid administration, vitalsigns and patient monitor inputs, provider events and other data.Non-operating room heath care locations are included within the scope ofthis disclosure. While this disclosure focuses on the totality offunctions offered by module 101, 201, each of the individual functionscan be offered independently of module 101, 201.

The use of the term Electronic Anesthetic Record (EAR) as defined hereincan include any memory such as an electronic surgical record (ESR), oran electronic medical record (EMR), or an electronic health record(EHR), and is not limited to anesthetic or surgical applications.Aspects of the modules 101,201 described herein can also be employed inrecovery, hospital room and long-term care settings.

In an example, the module 201 of FIG. 2 , can include a housing 299having a lower section 299A and a tower-like upper section 299B, whereinthe lower section 299A can be configured to house unrelated wasteheat-producing electronic and electromechanical surgical equipment, andwherein the tower-like upper section 299B can be located on top of thelower section 299A. The module 201 can also include a cowling 299Cexternal or internal to the housing 299 that substantially confineswaste heat generated by the unrelated waste heat-producing electronicand electromechanical surgical equipment. In addition, the module 201can include a system for monitoring the administration of one or more IVmedications and fluids 228, 230. As shown in the combination of FIGS. 2,4, 5 and 14 , the system 228, 230 can include any of: a barcode 436reader or an RFID 438 interrogator configured to identify the one ormore IV medications or fluids; a machine vision digital camera 436 tocapture an image of one or more of a syringe 406 or a drip chamber1434A,B; processing circuitry 257 operably coupled to the barcode reader436 or the RFID interrogator 438 (or the machine vision digital camera436) to receive the identity of the one or more IV medications orfluids, the processing circuitry 257 operably coupled to the machinevision digital camera 436 to receive the captured image and determine avolume of medication administered from the syringe or fluid administeredfrom an IV bag based on the image; and a display 226 operably coupled tothe processing circuitry 257, the display 226 configured to receiveinstructions from the processing circuitry 257 to output the identityand determined volume of medication administered from the syringe orfluid administered from an IV bag.

As described herein, “dose/response” can be a useful medical process.Dose-response includes giving something to the patient (a medicine forexample) or doing something to the patient (mechanical ventilation orsurgery for example)—the “dose”, and then observing the patient's“response.”

Healthcare data in general is manually entered, not automated.Healthcare data in general is also not granular (e.g., beat-by-beat,second-by-second, continuous) but rather very intermittent (e.g., every15 minutes, every 4 hours, every day etc.). In general, most data in theEMR are simply data that was on the old paper record, manually enteredinto the EMR.

Manual data entry of dose events, whether they are reporting medicationinjections, fluid infusions or changes in the ventilator settings or anyother “dose events” are laborious, distracting and universally dislikedby healthcare providers. Perhaps more important is that the dose eventsare not accurately recorded. First, there are innocent errors inrecording. Second, there are omissions that may be innocent or for lackof time or due to provider sloppiness. Finally, there is no temporalcorrelation between a dose event and a related response event becausethe dose event is most likely manually recorded minutes to hours afterthe dose event occurred (if it is recorded at all).

At this date, the only data that is automatic and timely recorded is the“response” data provided by the physiologic monitors. Even the monitorresponse data is usually not recorded beat-by-beat but ratherintermittently recorded every 5 minutes or 30 minutes or 4 hours forexample just as it was historically recorded on the paper record. Theremainder of the response data must be manually entered into the recordand thus suffers from the same limitations as noted above for themanually entered dose events. As a result, with current EMRs the doseand response data cannot be temporally correlated with any accuracy,vastly reducing the analytical and predictive value of the electronicdatabase and record. The systems described herein provide a technicalsolution to a technical problem. Furthermore, the benefits achieved bythe technical solutions of this disclosure exceed what can beaccomplished by manual processes.

In some examples, the automated data consolidation module 100, 200 ofthis disclosure includes systems and methods for constructing granular(beat-by-beat, second-by-second) anesthetic, surgical and patientrecords that include both “dose” events the things that are given ordone to the patient (inputs from medication injection and fluidmonitors, various support equipment and machine vision “observations”for example) and “response” events (inputs from electronic physiologicmonitors, various measurement devices and machine vision “observations”for example). In some examples, the automated data consolidation module100, 200 of this disclosure automatically enters both dose and responseevents into the electronic record. In some examples, the dose andresponse events of this disclosure are continually recorded, creating avery granular record. Electronic memory has gotten so inexpensive thatvast amounts of data can be practically recorded for analysis at a latertime. In some examples, the dose and response event data of thisdisclosure that do not change very fast or frequently, may becontinually recorded by the processing circuitry 157, 257 butintermittently recorded in the EMR to reduce the size of the record.

In some examples, the automated data consolidation module 100, 200 ofthis disclosure automatically enters both dose and response events intothe electronic record and temporally correlates the dose and responseevents when they are recorded. Temporally correlating the dose andresponse data can be accomplished by recording dose and response data inparallel, adding integrated or external time stamps to the dose andresponse data or any other suitable method of temporally matching thedata sets.

In an example, the module 201 of FIG. 2 , can include a housing 299having a lower section 299A and a tower-like upper section 299B, whereinthe lower section 299A can be configured to house unrelated wasteheat-producing electronic and electromechanical surgical equipment, andwherein the tower-like upper section 299B can be located on top of thelower section 299A. The module 201 can also include a cowling 299Cexternal or internal to the housing 299 that substantially confineswaste heat generated by the unrelated waste heat-producing electronicand electromechanical medical equipment. In some examples, theelectronic and electromechanical medical equipment may be mounted on themodule 201, 101. In some examples, the electronic and electromechanicalmedical equipment may be in electrical communication with the module201, 101. In some examples, the electronic and electromechanical medicalequipment may be wireless communication with the module 201 101.

In some examples, most of the electronic and electromechanical medicalequipment that are in, on or connected to the module are eitherparticipants in dose events (something given to or done to the patient)or participants in response events (measuring or observing the patient'sresponse). The physical location of the electronic and electromechanicalmedical equipment in or on the automated data consolidation module 100,200 of this disclosure, makes collecting data from the various equipmentvery efficient.

Unfortunately, most medical equipment available today does not produce adigital output signal that reports its operating settings andmeasurements in a recordable format. In some examples, the automateddata consolidation module 100, 200 allows rules to be applied to thevarious medical equipment that is housed within the module, mounted onthe module, or is in electrical communication with or in wirelesscommunication with the module. For example, the hospital or owner of theautomated data consolidation module 100, 200 could require that that allequipment in or on the module produce digital data reflecting theequipment's operating parameters and sensor inputs. Equipmentmanufacturers would have a business interest in adding digital outputsto their equipment if they want to sell their equipment to thathospital.

At this date there are few data standards for medical equipment and eachmanufacturer uses any data format that they choose. In some examples,the hospital or the owner of the “big data” database or the owner of theautomated data consolidation module 100, 200 could require that allequipment in or on the module produce data in prescribed data standardsand protocols so that translation of the data is not necessary. In someexamples, the data standards would document the expectations for one ormore of: format, definition, structuring, tagging, transmission,manipulation, use and management of the data. In some examples, the datastandard defines entity names, data element names, descriptions,definitions, and formatting rules. Translating data from one datastandard to another introduces the possibility of error. Therefore,producing data for input to the processing circuitry 157, 257 in theprescribed standards and formats minimizes the opportunity for error byavoiding data translation. However, in some examples, the processingcircuitry 157, 257 of the automated data consolidation module 100, 200includes software for translating data when necessary.

In some examples, the hospital or the owner of the “big data” databaseor the owner of the automated data consolidation module 100, 200 couldrequire that all equipment in or on the module produce data to aprescribed data model that includes all relevant input record fields forthat specific type of equipment. When data is used in “big data”databases, it is very common that there are missing data. The automateddata consolidation module 100, 200 of this disclosure can minimizemissing data by using prescribed data models for each type of equipmentand requiring that the data fields be filled. In some examples, the datastandard or data model also prescribe the format of the data in eachdata field. Labeling the fields with consistent labels helps when AIanalysis is done on the “big data.”

In some examples, the hospital or the owner of the “big data” databaseor the owner of the automated data consolidation module 100, 200 couldrequire that that all equipment in or on the module produce datainstantly. In some examples, instant data production is desirable sothat the processing circuitry 157, 257 can apply a time stamp or othertime designation to the data so that the data can be temporallycorrelated with other data. Instant data production also allows streamprocessing to be performed on the data for real-time feedback.Automating data input is far superior to manual data input for manyreasons. One of the important reasons is that automated input can acceptand record high volume, instantaneous data production allowing temporalcorrelations between dose event data and response event data.

In some examples, consistent data standards, consistent data formatting,consistent data fields, consistent data labeling and time stamping,produces data for a “big data” database that is most usable for AI andML analysis and research.

In some examples, consistent data standards, consistent data formatting,consistent data fields also produce data that is more protectable fromthe cyber security point of view. Having inputted structured andsemi-structured data with consistent data standards, consistent dataformatting, consistent data fields helps the processing circuitry 157,257 recognize inputted data that could be viral or malicious. In someexamples, the processing circuitry 157, 257 and software of theautomated data consolidation module 100, 200 can provide front lineaccess control and firewall protection, preventing corrupt data fromentering the system and being transferred to either the EMR or the “bigdata” database. In some examples, the processing circuitry 157, 257 andsoftware include one or more of access control software, firewallsoftware, antivirus software, anti-malware, anti-spyware, anti-tampersoftware, anti-subversion software and other cyber security software.

If the thousands of monitors and other pieces of medical equipment in ahospital inputted their data directly to the EMR, it would be verychallenging to provide cyber security on all of those inputssimultaneously. In some examples, since the automated data consolidationmodule 100, 200 is receiving data inputs from only 2-30 pieces ofmedical equipment and sensors, cyber security is much more manageable.Therefore, it may be advantageous to use the processing circuitry 157,257 and software of the automated data consolidation module 100, 200 toprovide cyber security on the inputted data. When the inputted data isknown to be secure, it can be freely transferred to the EMR or “bigdata” database without fear of corrupting the system.

In some examples, the hospital or the owner of the “big data” databaseor the owner of the automated data consolidation module 100, 200 couldrequire that that all equipment in or on the module produce datacontinuously. One of the “V's” of “big data” is volume the more data thebetter. Therefore, in some examples, data and measurements that arechanging may be recorded continuously to produce the most data “volume”for that data set. In some examples, the processing circuitry 157, 257and software can do data “filtering” in the presence of large size datato discard information that is not useful for healthcare monitoringbased on defined criteria. This may include for example, intermittentlyrecording data that changes slowly such as the patient's temperature,rather than continuously recording. In some examples, when the data isnot changing or changing very slowly, for example the settings on apiece of equipment or the patient's temperature, the processingcircuitry 157, 257 may record the data into the EHR or “big data”database, intermittently for efficiency, without losing any “volume.”

In some examples, the processing circuitry 157, 257 and software can dodata “cleaning” such as normalization, noise reduction and missing datamanagement. “Sensor fusion” is a technique that may be utilized tosimultaneously analyze data from multiple sensors, in order to detectand discard erroneous data from a single sensor. In some examples, theprocessing circuitry 157, 257 and software can be used in many otherways to cleanse, organize and prepare the input data. Data “filtering”and data “cleaning” prepare the data to enhance the reliability of datamining techniques. Processing raw data without preparation routines mayrequire extra computational resources that are not affordable in a “bigdata” context.

In some examples, the processing circuitry 157, 257 and software execute“stream processing” for applications requiring real-time feedback. Insome examples, streaming data analytics in healthcare can be defined asa systematic use of continuous waveform and related medical recordinformation developed through applied analytical disciplines, to drivedecision making for the patient care. In some examples, as shown in FIG.25 , a method for streaming healthcare data 2500 may start with fastdata ingestion 2502 which may include continuous waveforms such as EKGor pulse oximetry or other non-waveform data such as blood pressure2504. The next step in the process is situational and contextualawareness 2506, where the processing circuitry 157, 257 and softwarecorrelate and enrich the data set with data from the EHR, patienthistory, labs, allergies and medications and other data, or the like2508. The next step in the process is signal processing and featureextraction 2510, where advanced analytics 2512 consume relevant data toproduce insights. The final step in the process is producing actionableinsight 2514, which can include clinical decision support and alarms2516. In some examples, it is advantageous to regulate the access ofincoming data with access control and firewall software 2518.

In some examples, when the objective is to deliver data to a “big data”database, the data must be pooled. Data in the “raw” state needs to beprocessed or transformed. In a service-oriented architectural approach,the data may stay raw and services may be used to call, retrieve andprocess the data. In the data warehousing approach, data from varioussources is aggregated and made ready for processing, although the datais not available in real-time. The steps of extract, transform, and load(ETL) can be used to cleans and ready data from diverse sources. In someexamples, it is most efficient for the processing circuitry 157, 257 andsoftware of the automated data consolidation module 100, 200 of thisdisclosure, to process and transform the raw data before sending it tothe “big data” database.

An applied conceptual architecture of big data analytics 2600 inaccordance with some examples is shown in FIG. 26 . Data from multiplesources 2602 can be inputted into the processing circuitry 157, 257 andsoftware of the automated data consolidation module 100, 200. Big Datasources 2602 and data types include but are not limited to: Machine tomachine data—readings from remote sensors, meters and other vital signsdevices; big transaction data—health care claims and other billingrecords; biometric data—x-ray and other medical images, blood pressure,pulse and pulse-oximetry readings, and other similar types of data;human-generated data—unstructured and semi-structured data such as EMRsand physician notes. In some examples, it is advantageous to regulatethe access of incoming data with access control and firewall software2614.

In some examples, the processing circuitry 157, 257 and software of theautomated data consolidation module 100, 200 take the data and performthe steps of extract, transform, and load (ETL) 2604 to cleans and readythe data from diverse Big Data sources 2602. Once the data is processedor transformed, several options are available for proceeding with bigdata. A service-oriented architectural approach combined with webservices (middleware) is one possibility 2606. The data stays raw andservices are used to call, retrieve and process the data. Anotherapproach is data warehousing 2608 wherein data from various sources isaggregated and made ready for processing. With data warehousing 2608 thedata is not available in real-time.

Data transformation 2604 via the steps of extract, transform, and load(ETL), cleanses and readies the data from diverse sources 2602.Depending on whether the data is structured or unstructured, severaldata formats can be inputted to a big data analytics platform 2610. Bigdata is then organized into big data analytics applications 2612 such asqueries, reports, OLAP and data mining, so that it can be useful.

In some examples, with “big data” database data, the processingcircuitry 157, 257 and software may execute “batch processing,”analyzing and processing the data over a specified period of time. Batchprocessing aims to process a high volume of data by collecting andstoring batches to be analyzed in order to generate results. In someexamples, the processing circuitry 157, 257 and software can serve as a“node” in batch computing, where big data is split into small piecesthat are distributed to multiple nodes in order to obtain intermediateresults. Once data processing by nodes is terminated, outcomes will beaggregated in order to generate the final results. In some examples,stream processing and batch processing may be both used, either inparallel or sequentially.

In some examples, the automatically entered, temporally correlated doseand response events in the patient's electronic medical record (EMR) maybe analyzed by artificial intelligence (AI) and/or machine learning (ML)software in the processing circuitry 157, 257 of the module forimmediate advisory, alerts and feedback to the clinician. The patient'sown data can be analyzed by AI algorithms that were derived from generalmedical knowledge and research or may be analyzed by AI algorithms thatwere derived from AI analysis of the pooled database of many patients,such as machine learning (ML) or a combination of the two.

In some examples, the automatically entered, temporally correlated doseand response events in the patient's electronic record may be pooledwith the records of other patients in a database that can be analyzedwith artificial intelligence and machine learning software stored on amemory and executed by processing circuitry. This analysis can occur atthe time of temporal correlation or at a later time. This type ofanalysis is sometimes known as “big data.” The pooled data (e.g.aggregated data, compiled data, such as collective data of a group ofpatients, collective data for a specific patient over different periodsof time, doses, responses, medications, providers) may be stored onproprietary servers or may be stored in “the cloud.” In any event, the“big data” database of this disclosure is complete and granular(compared to current healthcare databases) because it was automaticallyentered and at least some of the data is continually recorded. The “bigdata” database of this disclosure includes both dose events and responseevents (compared to current healthcare databases that are weightedtoward response events) and the dose and response events are temporallycorrelated (compared to current healthcare databases). Temporalcorrelation can include time matching different sets of data streams.

“Big data” has been characterized by “four Vs”: Volume, Velocity,Variety and Veracity. In some examples, the automated data consolidationmodule 100, 200 of this disclosure addresses each of thesecharacteristics in order to optimize the acquired data for “big data”use and analysis.

Volume—The more data you have the better it is. The automated dataconsolidation module 100, 200 of this disclosure maximizes data volumeby collecting data not only from the physiologic monitors but also allof the OR equipment and other dose events including machine vision videoobservations. Further, the automated data consolidation module 100, 200can provide either continuous recordings or intermittent recordingsdepending on the speed of change in the data and the usefulness ofcontinuous data streams for any given data set or field.

Velocity—The data is accumulated in real-time and at a rapid pace. Theautomated data consolidation module 100, 200 of this disclosuremaximizes data velocity by automatically recording everything whichremoves manual data entry that slows the data acquisition process down.The ability to perform real-time analytics against such high-volume datain motion could revolutionize healthcare.

Variety—How different is the data. The automated data consolidationmodule 100, 200 of this disclosure maximizes data variety by recordingmost if not all structured and semi-structured data sources in the OR orother care locations, including but not limited to: physiologicmonitors, equipment, medication injections, dose events, responseevents, fluids and video with artificial intelligence (AI) and/ormachine learning (ML) analysis of the patient and delivered care. Insome examples, the automated data consolidation module 100, 200 may alsoaccept unstructured textual data entered by a keyboard, natural languagevoice recognition, from the EMR/EHR or other suitable source.

Veracity—How accurate is the data, the truthfulness of the data. Theautomated data consolidation module 100, 200 of this disclosuremaximizes data veracity by automatically recording the data withoutrequiring human input. In some examples, the automated dataconsolidation module 100, 200 of this disclosure includes Sensor Fusion,a data analytic system that monitors input data in order to rejectclearly mistaken inputs such as might occur if an EKG lead comes losefor example—improving the veracity of the database. Sensor Fusionanalyzes the input data from multiple sensors simultaneously in order todetect and reject inputs that are clearly erroneous. In some examples,Sensor Fusion may include a threshold-controlled artifact-removal moduleand/or a Kalman filter using statistical analysis to compare the inputdata streams.

In some examples, the automated data input feature of the automated dataconsolidation module 100, 200 is particularly important because theincreased variety of data input and high velocity of data input hinderthe ability to cleanse data before analyzing it and making decisions,magnifying the issue of data “trust.” The mere fact that the input isautomatic decreases the opportunity for human error.

In some examples as shown in FIGS. 1 and 2 , module 101, 201 of theautomated data consolidation module 100, 200 may consolidate a widevariety of equipment used for anesthesia and surgery. Some of thisequipment, including but not limited to: the physiologic monitors, theurine output monitor and the blood loss monitor and video observation ofthe patient with AI and/or ML analysis to produce response event datathat can be automatically recorded by the automated data consolidationmodule 100, 200.

In some examples as shown in FIGS. 1 and 2 , module 101, 201 of theautomated data consolidation module 100, 200 may consolidate a widevariety of equipment that produce dose event data, including but notlimited to: medication identification and measurement system 128, 228and the IV fluid identification and measurement system 130, 230, gasflow meters (not shown), the mechanical ventilator (not shown), thepneumoperitoneum insufflator (not shown), the electrosurgical generator(not shown) and video observation of the patient and provider with AIand/or ML analysis to produce dose event data that can be automaticallyrecorded by the automated data consolidation module 110, 200 (e.g., doseevent data can be received by processing circuitry 157, 257 and storedon one or more storage devices).

The automated data consolidation module 100, 200 not only physicallyconsolidates various electrical and electromechanical equipment but alsoconsolidates the data outputs of the various equipment for easyelectrical communication with the processing circuitry 157, 257. Theconsolidation of equipment in and on the module 101, 201 of theautomated data consolidation module 100, 200 solves another practicalobstacle currently preventing an automated dose/response record.Currently, much of the equipment mentioned above does not producedigital data that documents the equipment's operation because thevarious equipment manufacturers have chosen not to provide output data.The practical solution is that the provider of the automated dataconsolidation module 100, 200 can require that any equipment that is tobe located in or on the module 101, 201, must include data outputs andthe provider can also prescribe the digital standard and format so thatthe data can be organized efficiently and completely in a “big data”database. These benefits are not provided in any conventional system.

In some examples, it is anticipated that the automated dataconsolidation module 100, 200 can also accept input data from othermedical equipment and data sources by either wired or wirelessconnections. As with the equipment housed within or on the automateddata consolidation module 100, 200, it is preferable if the input datafollows the digital standard and format applied to the other equipment.However, in some examples the processing circuitry 157, 257 cantranslate input data that is not in the desired digital standard orformat.

Machine vision cameras and software are very good at measuringdistances, movements, sizes, looking for defects, fluid levels, precisecolors and many other quality measurements of manufactured products.Machine vision cameras and software can also be “taught” through AI andML to analyze complex and rapidly evolving scenes such as those in frontof a car driving down the road. Machine vision cameras and softwaredon't get bored or distracted.

FIG. 12 illustrates an isometric view of another example module 1201including an automated data consolidation module 1200 for generating anautomated electronic anesthetic record located proximate to a patient.

In some examples as shown in FIG. 12 , the automated data consolidationmodule 1200 of this disclosure includes systems and methods for usingmachine vision cameras 1299A,B and software to “observe” the patient. Ifthe patient is in surgery, the patient's head may be the focus of theobservation. In some examples, during surgery the machine vision cameras1299A,B and software may be “looking” for dose events including but notlimited to mask ventilation, endotracheal intubation or airwaysuctioning. In other words, the machine vision cameras 1299A,B cangenerate and send dose event information to be received and analyzed byprocessing circuitry 157, 257.

In some examples, during surgery the machine vision cameras 1299A,B andsoftware may be “looking” for (e.g., monitoring, sensing, detecting)response events including but not limited to: movement, grimacing,tearing or coughing or changes in skin color or sweating. In otherwords, the machine vision cameras 1299A,B can generate and send responseevent information to be received and analyzed by processing circuitry157, 257. Movement, grimacing, tearing and coughing are all signs of“light” anesthesia and that the patient may be in pain. Subtle changesin skin color from pinkish to blueish or grayish may indicate inadequateoxygenation or low perfusion. Subtle changes in skin color from pinkishto reddish may indicate hyperthermia or an allergic reaction. Sweatingmay indicate inadequate perfusion or hyperthermia. In any event,observing the patient is regarded by the American Society ofAnesthesiologists as the most basic of all monitors. Machine visioncameras 1299A,B and software do not get bored and can be programed torecognize subtle changes that may be missed by the human observer. Bothmovements and skin color changes may be subtle. The baseline color maybe very difficult for the observer to remember, whereas the machinevision cameras 1299A,B and software can precisely “remember” thebaseline color and recognize even subtle changes over time. In someexamples, pain may be detected by facial expression analysis, such as byprocessing circuitry 1257 receiving response event information from themachine vision cameras 1299A,B, analyzing such response eventinformation, and recording or displaying the information, or alerting aclinician or other personnel via a user interface, such as the display1226 or the remote display 1287, shown in FIG. 12 .

In some examples, vital signs such as heart rate, respiration rate,blood oxygen saturation and temperature can be measured remotely viacamera-based methods. Vital signs can be extracted from the opticaldetection of blood-induced skin color variations—remotephotoplethysmography (rPPG). In some examples, this technique works bestusing visible light and Red Green Blue (RBG) cameras. However, it hasalso been shown to work using near-infrared light (NIR) and NIR cameras.Just like pulse oximetry, a well-known technology for detecting pulseand blood oxygen saturation, rPPG relies on the varying absorption ofdifferent wavelengths of light caused by blood volume changes and theoxygen saturation of the blood in the small blood vessels beneath theskin. Unlike pulse oximetry that needs to be in contact with the skin,rPPG enables contactless monitoring of human cardiac activities bydetecting the pulse-induced subtle color changes on the human skinsurface using a regular RBG camera.

In some examples, this disclosure anticipates automating the remotephotoplethysmography using techniques such as, but not limited to,region of interest (RoI) detection and full video pulse extraction(FVP). In some examples, this disclosure also anticipates using acombination of visible light and near-infrared light wavelengths todetect different parameters. In some examples, additional measurementsare anticipated using the rPPG technology including but not limited tomeasuring blood glucose and hemoglobin levels.

FIG. 13 illustrates an isometric view of yet another example module 1301including an automated data consolidation module 1300 for generating anautomated electronic record located proximate to a patient.

In some examples as shown in FIG. 13 , if the patient is on the ward, inthe nursing home or other long-term care facility or at home, the wholepatient may be the focus of the observation. In some examples, if thepatient is on the ward, in the nursing home or other long-term carefacility, or at home, the machine vision cameras 1399 and software maybe “looking” for (e.g., sensing, monitoring, detecting) dose eventsincluding but not limited to repositioning the patient or suctioning theairway, feeding and eating, or assisting the patient out of bed or anyother nursing procedure.

In some examples, if the patient is on the ward, in the nursing home orother long-term care facility, or at home, the machine vision cameras1399 and software may be “looking” (e.g., sensing, monitoring,detecting) for response events including but not limited to restlessnessor getting out of bed without assistance, coughing or changes in thebreathing pattern or changes in skin color. Recent research has shownthat machine vision cameras 1399 and software with AI can recognizemoods with reasonable accuracy. The patient's mood could be an importantresponse event that should be recorded.

As shown in technique 2400 of FIG. 24 , various operations can beperformed by the dose-response systems 100, 200, 1200, 1300 andsubsystems disclosed herein. While the technique 2400 can be performedby the dose-response systems 100, 200, 1200, 1300, the technique 2400can also be performed by other systems, and the systems 100, 200, 1200,1300 can perform other techniques. In an example, a dose-response systemcan perform technique 2400 using processing circuitry and one or morestorage devices including a memory. The memory can have instructionsstored thereon, which when executed by the processing circuitry causethe processing circuitry to perform the operations. For example,operation 2402 can include receiving dose information (or dose event)from one or more sensors. Operation 2404 can include receiving responseinformation (or response event) from one or more sensors. The doseinformation can include data corresponding to a dose provided to thepatient, and the response information can include data corresponding toa response of the patient. Operation 2406 can include temporallycorrelating the dose information and the response information. Operation2408 can include saving the temporally correlated dose-responseinformation to at least one of the one or more storage devices such asstorage device 1516 of FIG. 15 . Temporally correlating dose-responseinformation can include continuously temporally correlating thedose-response information, such as in a processor-based timer, in abeat-by-beat, second-by-second type manner, as opposed to the extendedintervals and less accurate methods of traditional medical practice. Insome examples, temporally correlating the dose-response informationincludes temporally correlating the dose-response information, such asin a range between every 0.1 seconds to 5 minutes. In some examples, itmay be preferable to temporally correlate in a range between every 0.1seconds to 1 minute. It may be more preferable to temporally correlatein a range between every 1 second to 1 minute, however, any suitabletemporal correlation may be used to facilitate accurate, safe andmeaningful correlation where a direct, time-based relationship betweenthe dose and the response is captured.

In some examples, operation 2410 can include displaying informationcorresponding to the dose-response data. In operation 2412, if theprocessing circuitry detects a concerning response, the processingcircuitry can alert a user to the response. Operation 2414 can includeanalyzing the temporally correlated data. In some examples, operation2414 can include aggregating the temporally correlated dose-responseinformation with temporally correlated dose-response informationcollected from other patients. In some examples, operation 2414 caninclude aggregating the temporally correlated dose-response informationwith temporally correlated dose-response information collected from thesame patient over a different period of time. Comparing data from thesame patient may allow a provider to detect when a patient develops atolerance to a drug, such as a pain killer. In an example, if the rateof grimacing by the patient increases or they start to grimace sooner(e.g., response) after being given a pain medication (dose), as the painmedication is given over different days, weeks and months. Operation2414 can also facilitate machine learning.

In technique 2400, the dose information can include data/eventsgenerated by one or more of: an RFID interrogator, a barcode reader, aQR reader, a machine vision digital camera, any combination thereof, orany other suitable sensor. The response information can includedata/events generated by a machine digital camera or any other suitablesensor. The response information can include an image of one or moremovements, secretions or skin color changes, and the processingcircuitry can be configured to identify changes in the responseinformation. In some examples the processing circuitry can use machinelearning to identify changes in the response information. In someexamples, the response information includes physiologic data generatedby a physiologic monitor. For example, the physiologic data can includeat least one of: electrocardiogram, pulse oximetry, blood pressure,temperature, end-tidal CO₂, expired gases, respiratory rate, hemoglobin,hematocrit, cardiac output, central venous pressure, pulmonary arterypressure, brain activity monitor, sedation monitor, urine output, bloodloss, blood electrolytes, blood glucose, blood coagulability,train-of-four relaxation monitor data IV extravasation monitor data andbody weight, and any combination thereof or other suitable physiologicdata.

Implementation of any of the techniques described herein may be done invarious ways. For example, these techniques may be implemented inhardware, software, or a combination thereof. For a hardwareimplementation, the processing units may be implemented within on ormore application specific integrated circuits (ASICs), digital signalprocessors (DSPs), digital signal processing devices (DSPDs),programmable logic devices (PLDs), field programmable gate arrays(FPGAs), processors, controllers, micro-controllers, microprocessors,other electronic units designed to perform the functions describedabove, and/or a combination thereof.

Furthermore, embodiments may be implemented by hardware, software,scripting languages, firmware, middleware, microcode, hardwaredescription languages, and/or any combination thereof. When implementedin software, firmware, middleware, scripting language, and/or microcode,the program code or code segments to perform the necessary tasks may bestored in a machine-readable medium such as a storage medium. A codesegment or machine-executable instruction may represent a procedure, afunction, a subprogram, a program, a routine, a subroutine, a module, asoftware package, a script, a class, or any combination of instructions,data structures, and/or program statements. A code segment may becoupled to another code segment or a hardware circuit by passing and/orreceiving information, data, arguments, parameters, and/or memorycontents. Information, arguments, parameters, data, etc. may be passed,forwarded, or transmitted via any suitable means including memorysharing, message passing, token passing, network transmission, etc.

For a firmware and/or software implementation, the techniques may beimplemented with modules (e.g., procedures, functions, and so on) thatperform the functions described herein. Any machine-readable mediumtangibly embodying instructions may be used in implementing thetechniques described herein. For example, software codes may be storedin a memory. Memory may be implemented within the processor or externalto the processor. As used herein the term “memory” refers to any type oflong term, short term, volatile, nonvolatile, or other storage mediumand is not to be limited to any particular type of memory or number ofmemories, or type of media upon which memory is stored.

There are two common modes for ML: supervised ML and unsupervised ML.Supervised ML uses prior knowledge (e.g., examples that correlate inputsto outputs or outcomes) to learn the relationships between the inputsand the outputs. The goal of supervised ML is to learn a function that,given some training data, best approximates the relationship between thetraining inputs and outputs so that the ML model can implement the samerelationships when given inputs to generate the corresponding outputs.Unsupervised ML is the training of an ML algorithm using informationthat is neither classified nor labeled, and allowing the algorithm toact on that information without guidance. Unsupervised ML is useful inexploratory analysis because it can automatically identify structure indata. Either of supervised ML, or unsupervised ML can be used to trainthe systems described herein to correlate information from one or moresensors, such as a machine vision digital camera as having a particularmeaning. For example, either of supervised or unsupervised ML can beused to train the systems to correlate facial expressions with responseevents. The system can be trained to “read” a particular patient, or agroup of patients that may or may not include the particular patientbeing monitored.

Common tasks for supervised ML are classification problems andregression problems. Classification problems, also referred to ascategorization problems, aim at classifying items into one of severalcategory values (for example, is this object an apple or an orange?).Regression algorithms aim at quantifying some items (for example, byproviding a score to the value of some input). Some examples of commonlyused supervised-ML algorithms are Logistic Regression (LR), Naive-Bayes,Random Forest (RF), neural networks (NN), deep neural networks (DNN),matrix factorization, and Support Vector Machines (SVM).

Some common tasks for unsupervised ML include clustering, representationlearning, and density estimation. Some examples of commonly usedunsupervised-ML algorithms are K-means clustering, principal componentanalysis, and autoencoders.

FIG. 15 illustrates an example electronic and/or electromechanicalsystem 1500 of a medical system in accordance with some examplesdescribed herein. The system 1500 will be described with respect to theautomated data consolidation module 100, 200, but can include any of thefeatures described herein to perform any of the methods or techniquesdescribed herein, for example, by using the processor 1502. Theprocessor can include processing circuitry 157 or 257 of FIGS. 1 and 2 .In some examples, the processing circuitry 1502 can include but is notlimited to, electronic circuits, a control module processing circuitryand/or a processor. The processing circuitry may be in communicationwith one or more memory and one or more storage devices. A singleprocessor can coordinate and control multiple, or even all the aspectsof the system 1500 (e.g., of modules 101, 201), or multiple processorscan control all the aspects of the system 1500. In some examples thestorage device 1516 or memory 1504, 1506, 1516 can include at least aportion of the patient's anesthetic record saved thereon. The system1500 can also include any of the circuitry and electronic and/orelectromechanical components described herein, including but not limitedto, any of the sensor(s) described herein (e.g., sensors 1521), such asbut not limited to, RFID barcode or QR codes sensors, machine visioncameras, retinal scanners, facial recognition scanners, fingerprintreaders, actuators and position sensors described herein. The system1500 may also include or interface with accessories or other featuressuch as any of: a remote display or wireless tablet (e.g., 287, FIG. 2), as well as any of the other systems described herein.

The processing circuitry 1502 can receive information from the varioussensors described herein, make various determinations based on theinformation from the sensors, output the information or determinationsfrom the information for output on the display or wireless tablet,output instructions to provide an alert or an alarm, power variouscomponents, actuate actuators such as clamps and flow managing devices,etc., or alert another system or user, as described herein. For the sakeof brevity, select systems and combinations are described in furtherdetail above and in the example sets provided in the Notes and VariousExamples section below. Other embodiments are possible and within thescope of this disclosure.

Further, FIG. 15 illustrates generally an example of a block diagram ofa machine (e.g., of module 101, 201) upon which any one or more of thetechniques (e.g., methodologies) discussed herein may be performed inaccordance with some embodiments. In alternative embodiments, themachine 1500 may operate as a standalone device or may be connected(e.g., networked) to other machines. In a networked deployment, themachine 1500 may operate in the capacity of a server machine, a clientmachine, or both in server-client network environments. The machine1500, or portions thereof may include a personal computer (PC), a tabletPC, a personal digital assistant (PDA), a mobile telephone, a webappliance, a network router, switch or bridge, or any machine capable ofexecuting instructions (sequential or otherwise) that specify actions tobe taken by that machine. Further, while only a single machine isillustrated, the term “machine” shall also be taken to include anycollection of machines that individually or jointly execute a set (ormultiple sets) of instructions to perform any one or more of themethodologies discussed herein, such as cloud computing, software as aservice (SaaS), other computer cluster configurations.

Examples, as described herein, may include, or may operate on, logic ora number of components, modules, or like mechanisms. Such mechanisms aretangible entities (e.g., hardware) capable of performing specifiedoperations when operating. In an example, the hardware may bespecifically configured to carry out a specific operation (e.g.,hardwired). In an example, the hardware may include configurableexecution units (e.g., transistors, circuits, etc.) and a computerreadable medium containing instructions, where the instructionsconfigure the execution units to carry out a specific operation when inoperation. The configuring may occur under the direction of theexecution units or a loading mechanism. Accordingly, the execution unitsare communicatively coupled to the computer readable medium when thedevice is operating. For example, under operation, the execution unitsmay be configured by a first set of instructions to implement a firstset of features at one point in time and reconfigured by a second set ofinstructions to implement a second set of features.

Machine (e.g., computer system) 1500 may include a hardware processor1502 (e.g., processing circuitry 157, 257, a central processing unit(CPU), a graphics processing unit (GPU), a hardware processor core, orany combination thereof), a main memory 1504 and a static memory 1506,some or all of which may communicate with each other via an interlink(e.g., bus) 1508. The machine 1500 may further include a display unit1510, an alphanumeric input device 1512 (e.g., a keyboard), and a userinterface (UI) navigation device 1514 (e.g., a mouse). In an example,the display device 1510, an input device such as an alphanumeric inputdevice 1512 and UI navigation device 1514 may be a touch screen display.The display unit 1510 may include goggles, glasses, or other AR or VRdisplay components. For example, the display unit may be worn on a headof a user and may provide a heads-up-display to the user. Thealphanumeric input device 1512 may include a virtual keyboard (e.g., akeyboard displayed virtually in a VR or AR setting.

The machine 1500 may additionally include a storage device (e.g., driveunit) 1516, a signal generation device 1518 (e.g., a speaker), a networkinterface device 1520, and one or more sensors 1521, such as a globalpositioning system (GPS) sensor, compass, accelerometer, or othersensor. The machine 1500 may include an output controller 1528, such asa serial (e.g., universal serial bus (USB), parallel, or other wired orwireless (e.g., infrared (IR), near field communication (NFC), etc.)connection to communicate or control one or more peripheral devices oractuators of the system. Peripheral devices can include but are notlimited to any displays, controllers or memories in electricalcommunication with the system, and actuators can include but are notlimited to: one or more stop-flow clamps 1060A,B (FIG. 10 ) and one ormore flow rate clamps 1478 (FIG. 14 ) of the system.

The storage device 1516 may include a machine readable medium 1522 thatis non-transitory on which is stored one or more sets of data structuresor instructions 1524 (e.g., software) embodying or utilized by any oneor more of the techniques or functions described herein. Theinstructions 1524 may also reside, completely or at least partially,within the main memory 1504, within static memory 1506, or within thehardware processor 1502 during execution thereof by the machine 1500. Inan example, one or any combination of the hardware processor 1502, themain memory 1504, the static memory 1506, or the storage device 1516 mayconstitute machine readable media that may be non-transitory.

While the machine readable medium 1522 is illustrated as a singlemedium, the term “machine readable medium” may include a single mediumor multiple media (e.g., a centralized or distributed database, orassociated caches and servers) configured to store the one or moreinstructions 1524.

The term “machine readable medium” may include any medium that iscapable of storing, encoding, or carrying instructions for execution bythe machine 1500 and that cause the machine 1500 to perform any one ormore of the techniques of the present disclosure, or that is capable ofstoring, encoding or carrying data structures used by or associated withsuch instructions. Non-limiting machine-readable medium examples mayinclude solid-state memories, and optical and magnetic media. Specificexamples of machine readable media may include: non-volatile memory,such as semiconductor memory devices (e.g., Electrically ProgrammableRead-Only Memory (EPROM), Electrically Erasable Programmable Read-OnlyMemory (EEPROM)) and flash memory devices; magnetic disks, such asinternal hard disks and removable disks; magneto-optical disks; andCD-ROM and DVD-ROM disks.

The instructions 1524 may further be transmitted or received over acommunications network 1526 using a transmission medium via the networkinterface device 1520 utilizing any one of a number of transferprotocols (e.g., frame relay, internet protocol (IP), transmissioncontrol protocol (TCP), user datagram protocol (UDP), hypertext transferprotocol (HTTP), etc.). Example communication networks may include alocal area network (LAN), a wide area network (WAN), a packet datanetwork (e.g., the Internet), mobile telephone networks (e.g., cellularnetworks), Plain Old Telephone (POTS) networks, and wireless datanetworks (e.g., Institute of Electrical and Electronics Engineers (IEEE)802.11 family of standards known as Wi-Fi®, IEEE 802.16 family ofstandards known as WiMax®), IEEE 802.15.4 family of standards,peer-to-peer (P2P) networks, among others. In an example, the networkinterface device 1520 may include one or more physical jacks (e.g.,Ethernet, coaxial, or phone jacks) or one or more antennas to connect tothe communications network 1526. In an example, the network interfacedevice 1520 may include a plurality of antennas to wirelesslycommunicate using at least one of single-input multiple-output (SIMO),multiple-input multiple-output (MIMO), or multiple-input single-output(MISO) techniques. The term “transmission medium” shall be taken toinclude any intangible medium that is capable of storing, encoding orcarrying instructions for execution by the machine 1500, and includesdigital or analog communications signals or other intangible medium tofacilitate communication of such software.

Method examples described herein may be machine or computer-implementedat least in part. Some examples may include a computer-readable mediumor machine-readable medium encoded with instructions operable toconfigure an electronic device to perform methods as described in theexamples. An implementation of such methods may include code, such asmicrocode, assembly language code, a higher-level language code, or thelike. Such code may include computer readable instructions forperforming various methods. The code may form portions of computerprogram products. Further, in an example, the code may be tangiblystored on one or more volatile, non-transitory, or non-volatile tangiblecomputer-readable media, such as during execution or at other times.Examples of these tangible computer-readable media may include, but arenot limited to, hard disks, removable magnetic disks, removable opticaldisks (e.g., compact disks and digital video disks), magnetic cassettes,memory cards or sticks, random access memories (RAMS), read onlymemories (ROMs), and the like.

Some of the benefits of the automated data consolidation module 100, 200of FIGS. 1 and 2 and the subsystems described throughout thisdisclosure, and including the machine 1500 (FIG. 15 ), can includefeatures to help with monitoring medication, fluid and anesthesiadelivery, as well as documenting medication, fluid and anesthesiadelivery, as well as other functions. In general, doctors and nurses arenot interested in replacing themselves and their jobs with automateddrug delivery or automated anesthesia systems. However, there is greatinterest in automated record keeping. Virtually all healthcare providerswould prefer the “old” paper record and a pen to the “new” computerrecords. Filling out the electronic medical record (EMR) using acomputer keyboard, mouse and various menus is widely viewed as a slow,cumbersome and distracting process. The challenge with automated recordkeeping is automating the data input that documents the numerousactivities, anesthesia related events, fluid, gas and medicationadministration, ventilator settings, pressure off-loading effectiveness,as well as outputs such as blood loss and urine output, that constitutean anesthetic experience.

A challenge in implementing the automated data consolidation module 100,200 with an automated electronic anesthetic record (EAR) or electronicmedical record (EMR) is to force as little change in the caregiver'sroutine as possible onto the clinicians using this system. Medicalpersonnel tend to be creatures of habit and tradition and they generallydo not like change. For example, IV medications are traditionallyadministered from a syringe and the dose is determined by the caregiverobserving the plunger moving relative to a scale printed on the syringe.Maintaining this general technique of drug administration may have thehighest probability of acceptance by healthcare users who are typicallyslow to embrace changes in their routine.

Further, with regard to benefits of the modules, systems and machinesdescribed herein, the automated data consolidation module 200 of module201 can generate an automated electronic medical record (EMR) with themodule 201 locatable proximate to the patient 202. The module 201 can bea module for housing unrelated electronic and electromechanical surgicalequipment. The module 201 need not necessarily be configured to houseunrelated electronic and electromechanical surgical equipment in allexamples, and other modules can include the system for generating anautomated EMR.

The module 201 can be an automated EMR system that can include one ormore systems (e.g., 200, 228, 230) configured to measure (e.g., monitor)and record one or more of functions involved in a surgical anestheticenvironment, and can include life support functions. The one or moresystems 228, 230 can measure and record data automatically. However, insome examples, a user may initiate any of the systems described hereinto measure and/or record data. These various measurements may beelectronically recorded (such as on mass storage 1516 (FIG. 15 ) anddisplayed on the electronic anesthetic record display 226 (e.g., displaydevice 1510, FIG. 15 ). Inputs to the automated EMR system may bemanaged by the anesthetic record input component 224 (e.g., input device1512; FIG. 15 ). The anesthetic record input component 224 (e.g., inputdevice 1512; FIG. 15 ) can include a touch-screen display 226 thatorganizes all of the inputs to the EMR into easily accessed and utilizedinformation. In some examples, and as shown in FIG. 2 , theidentification and measurement system 228 of this disclosure may belocated proximate the patient 202. The control displays for theidentification and measurement system 228 may include a dedicateddisplay proximate the identification and measurement system 228 or maybe shared space on the anesthetic record input component 224 or display226. In these locations, the information and controls of theidentification and measurement system 228 can be viewed by theanesthesiologist or other user, in a single field of vision with thepatient and surgical field.

Example methods of employing the systems, modules and machines disclosedherein are described throughout this disclosure and in the methods ofFIGS. 16-21 which are illustrative in nature. Other methods describedherein may also be performed by the systems, modules and machinesdescribed herein, and the systems modules and machines described hereinmay be used to perform other methods.

FIGS. 16-18 show flow charts illustrating techniques for identification,measurement, monitoring, security and safety related to medicationsand/or IV fluids. The methods may be used with the systems, sub-systemsand modules of FIGS. 1-15 (e.g., 101, 201, 1500), but may also be usedwith other systems. Likewise, the systems, subsystems of modules ofFIGS. 1-15 may also be used with other methods. The techniques 1600,1700, 1800, 1900, 2000, 2100, 2300 can be performed by at least onenon-transitory machine-readable medium (e.g., computer readable)including instructions for operation of the systems described herein.Some steps of techniques may be performed by a provider. The systems caninclude processing circuitry (e.g., 157, 257, 1500, including one ormore processors, processing circuitry hardware) for executing theinstructions. The instructions, when executed by the processingcircuitry can cause the processing circuitry to perform operationsdescribed in FIGS. 16-21 and 23 , and as described in the examplesthroughout this disclosure.

FIG. 16 is a flow chart illustrating an example technique 1600 of IVfluid identification and measurement. To start the technique, inoperation 1602 a provider hangs an IV fluid bag and attached dripchamber on electronic scale hooks in an IV fluid identification andmeasurement unit (e.g., FIG. 14 ). In operation 1604, a machine visioncamera and software can identify the fluid and bag by the barcode labelon the IV fluid bag. In operation 1606, the machine vision camera andsoftware can identify the individual drops in the drip chamber andmeasure the size of the drop to determine the fluid volume per drop andcount the number of drops per unit time. In operation 1608 the machinevision camera and software can calculate the flow rate by multiplyingthe number of drops per unit time by the volume/drop. In operation 1610,the fluid flow rate is displayed and document in the EMR.

In operation 1612, if the machine vision camera and software fails toidentify individual drops in the drip chamber, in operation 1614 themachine vision camera and software can look for a floating ball (e.g.,float) that is located in the drip chamber to determine if the ball isfloating and if the ball is moving. In operation 1616, when the ball isnot floating and/or moving, IV clamps are closed and the provider canchange the empty IV bag if necessary. In operation 1618, if the machinevision camera and software can determine that the ball is floating andmoving, the system determines that the fluid flow is so fast that thefluid flow is constant or continuous such that individual drops cannotbe measured. In operation 1618, because individual drops cannot bedetermined, the system switches to measuring the fluid flow rate usingan electronic IV scale (FIG. 14 ) to determine the fluid flow rate. Inoperation 1620, the fluid flow rate can be determined by monitoring thechange in IV bag weight per time. In operation 1622, the fluid flow ratecan be displayed and documented in the EMR.

FIG. 17 is a second flow chart illustrating a technique 1700 includingaspects of the technique 1600 of IV fluid identification and measurementfrom the perspective of processing circuitry (e.g., 257, FIG. 2 ; 1502,FIG. 15 ). The technique 1700 may include an operation 1702 to receiveIV fluid identification information from a first IV sensor (e.g., one ormore sensors), such as an RFID or barcode reader to identify the fluidor other characteristics of an IV fluid bag as described herein.Operation 1704 can include saving the IV identification information to astorage device (e.g., one or more storage devices, memory, EMR).Operation 1706 can include to receive fluid drop information from asecond IV sensor, such as a machine vision camera that detects, sensesand measures an individual drop in a drip chamber to determine a fluidvolume per drop and measure the number of drops per unit of time. Whilethe illustrative example of FIG. 17 includes the first IV sensor and thesecond IV sensor, in some examples the first IV sensor and the second IVsensor can be the same sensor or same one or more sensors. Operation1708 can include to determine if a fluid drop was recognized by thesecond IV sensor. If in operation 1708 it is determined that a fluiddrop was recognized, operation 1710 can include determining a fluid flowrate, such as by calculating the flow rate by multiplying the number ofdrops per unit time by the volume per drop. In some examples, the volumeper drop is measured, while in other examples the volume per drop may beinput by a user, or can be a value retrieved from a memory. Operation1712 can include transmitting instructions to a display to cause a fluidflow rate to be displayed. Operation 1714 can include saving flow rateinformation to the storage device to document the fluid flow rate in theEMR. Any time a change is input or detected in the system, updated flowrate information can be displayed and saved.

If in operation 1708 it is determined that a fluid drop was notrecognized, operation 1616 can include receiving float information fromthe second IV sensor or another IV sensor. The float information caninclude information about a float in the drip chamber including is thefloat still (e.g., not moving), moving, or is movement of the floatslowing down. Operation 1718 can include determining if the float ismoving. If the float is moving. Operation 1720 can include determiningthe fluid flow is constant. In such a scenario, the fluid is flowing butthe fluid is flowing so quickly that individual drops of fluid cannot bedistinguished because the fluid is flowing as a steady stream. Operation1720 can further include determining the fluid flow rate by receiving IVbag physical characteristic information from a physical characteristicsensor, such as a weight sensor. The physical characteristic informationcan include weight information from the weight sensor (e.g., scale).Operation 1722 can include determining the fluid flow rate bycalculating the change in IV bag weight over a period of time. In otherexamples, instead of weight information, the physical characteristicinformation can include a position of the IV bag that changes as aresult of a change in weight, without the physical characteristic datacorresponding directly to a weight measurement. Other physicalcharacteristics and other physical characteristic sensors configured tomonitor IV fluid delivery may be provided such that an automated, or atleast partially automated EMR system is enabled.

If in operation 1718 it is determined that the float is not moving,operation 1728 can include determining that no fluid is flowing from theIV bag and transmitting one or more of: an instruction an actuator suchas a clamp, to cause the actuator to inhibit fluid flow to the patient(e.g., close the clamp onto IV tubing to prevent flow); and transmit andinstruction to an indicator (e.g., display, audible, tactile indicator)to cause an alert to be generated. Operation 1730 can include saving ano fluid event to the storage device.

FIG. 18 is a flow chart illustrating an example technique 1800 ofmedication identification and measurement. In operation 1802 a providerinserts a medication syringe into an injection portal (e.g., 411, FIG. 4). In operation 1804 the medication can be identified by a sensor suchas by at least one of the RFID, barcode or QR sensors described herein,in operation 1806 processing circuitry checks for medication errors bycomparing the medication against one or more of: a doctor's orders,allergy history, medical history, other medications and current vitalsigns. In operation 1808, the results of the medication error check canbe displayed on an electronic record display. The results can indicateno error, the presence of an error, specific details about the error, orpresent a link to access information including additional details aboutthe error. In operation 1810, if a serious medication error isrecognized, the error deploys (e.g., causes actuation of) IV tubingclamps (e.g., 1060A, 1060B of FIG. 10 ) to prevent injection of themedication.

If in operation 1812, such as when no errors are determined, the machinevision camera and software can measure the diameter of the syringe. Inoperation 1814, an image of, or representation of the image of thesyringe, is displayed on the electronic record display. In operation1816 the provider squeezes the plunger of the syringe. In operation1818, the machine vision camera and software measure the distancetraveled by the syringe's plunger seal (e.g., 548, FIG. 5 ). Inoperation 1820 the processing circuitry calculates the volume injectedby multiplying the syringe diameter times the distance of plungertravel. The processing circuitry can also calculate the dose bymultiplying the volume injected by the concentration of the medication.In operation 1822 the injected dose and volume are displayed on theelectronic record display. In operation 1824 the injected dose andvolume are time stamped and recorded in the electronic medical record.

FIG. 19 is a second flow chart illustrating a technique 1900 includingaspects of the technique 1800 of medication identification andmeasurement from the perspective of processing circuitry (e.g., 157,FIG. 1 ; 257, FIG. 2 ; 1502, FIG. 15 ).

Technique 1900 can include an operation 1902 to receive medicationidentification information such as medication type, concentration,brand, lot number or amount, from a first medication sensor (e.g., RFID,barcode or QR reader). Operation 1904 can include saving medicationidentification information to a storage device (e.g., one or morestorage devices, memory). Operation 1906 can include comparingmedication identification information to at least one of a medicationorder, allergy history, medical history, other medications ordered forthe patient, and vital signs (e.g., previously obtained vital signs orcurrent vital signs of the patient via continuous monitoring). Operation1908 can include determining if a medication error is present. Operation1910 can include receiving syringe information from a second medicationsensor (e.g., a sensor configured to measure diameter, such as a machinevision camera). Operation 1912A can include receiving medicationdelivery information from the second medication sensor or anothermedication sensor. some examples, the medication delivery informationcan include a distance of a syringe plunger travel.

Operation 1912B can include transmitting instructions to a display tocause an image of the syringe (e.g., actual image or representation ofthe syringe) to be displayed. A representation of the syringe caninclude an image communicating information about the syringe that is notan image of the actual syringe or can be a modified image of thesyringe, such as to highlight or point out aspects of the syringe ormedication within the syringe

Using the medication delivery information obtained in operation 1912A,operation 1914 can include determining a medication delivery amount.Operation 1916 can include transmitting instructions to a display (e.g.,display 226, FIG. 2 ) to cause the medication delivery information ormedication delivery amount to be displayed.

If in operation 1908 it is determined that a medication error ispresent, operation 1920 can include transmitting instructions includingerror information to the display or another display to cause the errorinformation to be displayed. In some examples, any of the instructionsdescribed herein that are sent to the display can be sent to one or moredisplays. Such displays can be located locally or remotely (e.g., in adifferent part of a room, in a separate room, in another building, inanother state, in another country), to alert multiple providers. Forexample, a provider such as a nurse anesthetist located adjacent to thepatient can be alerted to and provided with the information via display226. In addition, a second provider, such as an anesthesiologistsupporting the nurse anesthetist, and who may be supporting other nurseanesthetists working in different rooms, can also be alerted on adisplay of a mobile device, which may prompt them to check in with andpotentially assist the nurse anesthetist. This concept can be applied.outside the operating room to manage medication delivered by providersworking in different rooms of a hospital or other care center, while asecond provider such as a nurse manager, nurse practitioner, pharmacistor doctor oversees the work of the first provider. In operation 1922 theerror information can be saved to one or more storage devices (e.g.,259, FIG. 2 ; 1516, FIG. 15 ).

Also in response to determining that a medication error has occurred inoperation 1908, operation 1924 can include transmitting instructions toan actuator such as an IV tubing clamp to inhibit (e.g., prevent,reduce, limit) injection. In some examples, the actuator can reduce orlimit the amount of the injection to a specified amount rather thancompletely inhibiting or preventing administration of the medication.Operation 1926 can include saving an inhibit injection event informationto a storage device, such as any of the one or more storage devices(e,g., 259, FIG. 2 ; 1516, FIG. 15 ). The inhibit injection eventinformation can include information such as the time of the event andthe action taken to inhibit injection and how much the injection wasinhibited (e.g., partially inhibited, completely inhibited, or amount ofmedication inhibited from injection).

If in operation 1908 it is determined that a medication error has notoccurred, operation 1910 can include receiving syringe informationincluding a syringe diameter from a sensor such as a machine visioncamera. In some examples, the sensor can be the first medication sensoror can be a second medication sensor. Operation 1912A can includereceiving medication delivery information from a sensor such as from thefirst medication sensor, the second medication sensor or another sensor.The medication delivery information can include a distance of plungertravel relative to a syringe body. Operation 1912B can includetransmitting instructions to one or more displays such as, display 226,FIG. 2 , to cause an image of the syringe or representation of thesyringe to be displayed.

Operation 1914 can include determining a medication delivery amount,such as a volume or dose injected. For example, the volume injected canbe calculated by multiplying the syringe diameter by the distance ofplunger travel. The dose injected can be calculated by multiplying thevolume injected by the concentration of the medication.

Operation 1916 can include transmitting instructions to the one or moredisplays to cause the medication delivery information to be displayed.Operation 1918 can include saving medication delivery information to thestorage device (e.g., EMR). In some examples, the medication deliveryinformation can include, but is not limited to, volume, dose, time ofthe injection, or time period of the injection.

FIG. 20 is a flow chart illustrating an example of a second technique ofIV fluid identification and measurement including safety and securitymeasures. Aspects of technique 2000 can be similar or the same astechniques 1800 and 1900, however, technique 2000 is particularlywell-suited to the challenges of maintaining safety and security withcontrolled drugs such as narcotics. Technique 2000 can include operation2002 of identifying a medication (e.g., a controlled drug) andidentifying a health care provider, such as by RFID, barcode or QR codereader, retinal scanner, facial recognition, or fingerprint. Operation2002 can occur at the time a provider checks out a drug from a pharmacyor a medication dispensing machine. The medication can include anarcotic in a tamper-proof, non-refillable syringe.

Operation 2004 can include identifying a provider such as by barcode orQR code reader, retinal scanner, facial recognition, or fingerprint at apatient's bedside, such as at an injection portal (e.g., 411, FIG. 4 ).The provider can be the same or a different provider as the provider inoperation 2002. In operation 2006, the provider inserts the medicationsyringe into the patient's injection portal. In operation 2008, thecontrolled drug is identified, such as by an RFID, barcode or QR codereader associated with the injection portal. Operation 2010 can includeprocessing circuitry checking for medication errors by comparing themedication against doctor's orders, allergy history, medical history,other medications and vital signs. Operation 2012 can include displayingmedication error check results on a display, such as display 226, FIG. 2. If the medication error is of a serious nature, the error can cause IVtubing clamps to prevent injection. Operation 2016 can include machinevision camera and software measuring the diameter of the syringe.Operation 2018 can include an image, or an image representing thesyringe being displayed on a display, such as display 226, FIG. 2 .Operation 2020 can include a provider squeezing the plunger of thesyringe. Operation 2022 can include the machine vision camera andsoftware measuring the distance traveled by the syringe's plunger seal(e.g., 548, FIG. 5 ). Operation 2024 can include processing circuitrydetermining the volume of medication injected by multiplying the syringediameter by the distance of plunger travel or determining the dose ofmedication injected by multiplying the volume of medication injected bythe concentration of the medication. Operation 2026 can includedisplaying the injected volume or dose on a display, such as display226, FIG. 2 .

Operation 2028 can include saving the injected volume or dose along witha timestamp to the EMR. Operation 2030 includes repeating the operationsof technique 2000 as necessary until the machine vision camera andsoftware documents an empty syringe. Operation 2032 includes completingthe “chain of custody” for a specific syringe of controlled medication.The operations of technique 2000 can be repeated as necessary for othersyringes, thereby completing the “chain of custody” for each syringe.

FIG. 21 is a second flow chart illustrating a technique 2100 includingaspects of the technique 2000 of IV fluid identification and measurementincluding safety and security measures from the perspective ofprocessing circuitry, such as, but not limited to, processing circuitry157, FIG. 1 ; 257, FIG. 2 ; 1502, FIG. 15 . The technique may involveprocessing circuitry 2202B, such as may be part of a medication vendingsystem as shown in FIG. 22 . FIG. 22 illustrates generally an example ofa block diagram of vending system and a medication delivery system ofFIGS. 1-21 and 23 upon which any one or more of the techniques (e.g.,methodologies) discussed herein may perform in accordance with someembodiments. FIGS. 21 and 22 are described together.

In some examples, operations 2102 and 2104 can be part of a vendingsystem (2202, FIG. 22 ) for managing medication withdrawal from apharmacy or other vending system. Operations 2110-2136 can be part of amedication delivery system (e.g., can be used with the bedside patientsystems and modules shown and describe in FIGS. 1-15 ; medicationdelivery system 2210, FIG. 22 ). Operation 2138 can tie information,including data generated by the vending system 2202 and the medicationdelivery system 2210 together to facilitate tracking a “chain ofcustody” for a specific syringe of controlled medication from thepharmacy until the medication is completely injected into the patient.Chain of custody information can be stored to one or more of: thevending system storage 2202A, the medication delivery storage 2216, andchain of custody storage device (e.g., 2206, FIG. 22 ) and the EMR. Anyof the storage described herein can include one or more storage devicesor memory as described herein and can include other storage devices inelectrical communication with the vending system or the medicationdelivery system.

Operation 2102 of the vending system can include receiving withdrawingprovider identification information from a medication dispensing sensor2202C, such as a first RFID or barcode reader that reads a badge of aprovider and reads the medication identification information from asyringe or other medication container, or any other type of suitablesensor described herein. Operation 2104 can include associating andsaving the medication identification information and the withdrawingprovider identification information to a vending system storage device(e.g., 2202A, FIG. 22 ).

Operation 2110 can include receiving medication identificationinformation from a first identification sensor (e.g., RFID, QR, barcodereader, or machine vision camera reads information about a medication)and receiving delivery provider identification information from thefirst identification sensor or another identification sensor (e.g., asecond identification sensor, another RFID, QR or barcode reader,machine vision camera, retinal scanner, facial recognition sensor orfingerprint reader). In some examples, patient identificationinformation can also be obtained from one of the first identificationsensor, second identification sensor or another identification sensor,such as by scanning patient identification information on a hospitalwristband. In some examples receiving the medication identification, theprovider identification information or the patient identification cancause the processing circuitry to send an instruction to a display toprompt the user for the other of the medication identificationinformation, the provider identification information or the patientidentification information.

Operation 2112 can include comparing the received identificationinformation to one or more of: a medication order, allergy history,medical history, other medications and current vital signs. Operation2114 can include determining if a medication error is present. If it isdetermined that a medication error is present, operation 2116 caninclude transmitting instructions including error information to adisplay to cause the error information to be displayed. Operation 2118can include saving the error information to one or more storage devices.Further, if in operation 2114 it is determined that a medication errorhas occurred, operation 2120 can include transmitting inhibit injectioninstructions to an actuator such as , but not limited to, an IV tubingclamp (e.g., 1060A, 1060B; FIG. 10 ) to inhibit injection. Operation2122 can include saving an inhibit injection event information to one ormore storage devices.

Operation 2124 can include receiving syringe information from a secondmedication sensor (e.g., syringe diameter including syringe innerdiameter, outer diameter, or wall thickness from a machine visioncamera). Operation 2124 can include receiving syringe size informationfrom a data storage device, the syringe size information provided by thesyringe manufacturer that supplies the specific syringes used by thespecific healthcare facility. Operation 2126 can include transmittinginstructions to a display to cause an image of the syringe or arepresentation of the syringe to be displayed. Operation 2128 caninclude receiving syringe movement information from the secondmedication sensor or another sensor. Syringe movement information caninclude, for example, a distance of travel of the syringe plungerrelative to the syringe barrel.

Operation 2130 can include determining medication delivery informationbased on the syringe movement information. Medication deliveryinformation can include, for example, a volume or dose of medicationdelivered to the patient (e.g., ejected from the syringe). In someexamples, the volume of medication delivered (e.g., ejected from thesyringe) can be calculated by multiplying the syringe inner diameter bythe distance of plunger travel. Likewise, the dose of medicationdelivered can be calculated by multiplying the calculated volume by aconcentration of the medication. Operation 2132 can include savingmedication delivery information to one or more storage devices. In otherwords, operation 2132 can include documenting volume, dose and time inan EMR, in some cases automatically without intervention from aprovider.

Operation 2134 can include transmitting instructions to one or moredisplays described herein to cause the medication delivery informationto be displayed. Operation 2136 can include determining that a syringeis empty and saving “chain of custody” complete for the specific syringeof medication (e.g., controlled drug) to one or more storage devices.

To complete and document the chain of custody, thereby ensuring themedication was delivered to the patient, operation 2138 can include oneor more of receiving, associating and saving to one or more chain ofcustody storage devices (e.g., 2206, FIG. 22 ), information from boththe pharmacy vending system 2202 (FIG. 22 ) and the bedside medicationdelivery system 2210 (FIG. 22 ) (e.g., 1516; FIG. 15 ). In some examplesthe one or more chain of custody storage devices is not necessarilyseparate from the vending system storage 2202A or the medicationdelivery storage 2216, but rather can reside with one or the othersystems, a different system, multiple systems or can be included as asingle storage device.

FIG. 23 illustrates and example technique 2300 for assessingphysiological events. In some examples, the EMRs created by theautomated data consolidation module 100, 200, 400, 600, 800 can providethe most accurate and temporally correlated information about therelationship between any injected medication and the resultingphysiologic response. In some examples, this is uniquely accuratedose-response data can be used as a final check of the chain of custodyfor controlled medications or any medication. The processing circuitry157, 257 may include or be in electrical communication with artificialintelligence (AI) and/or machine learning that can compare the measuredphysiologic response in the several minutes after a medication isinjected, to the expected physiologic response for that dose of thatmedication. For example, if the injected medication was a narcotic, itwould be expected that the heart rate and blood pressure of the patientwould decrease quickly after the injection.

In some examples, if the expected physiologic response does not occur,the AI software of the automated data consolidation module 100, 200,400, 600, 800 may electronically “flag” that injection as suspicious.For example, if there is no physiologic response after injecting whatwas supposed to be a narcotic, it is possible that the drug had beenstolen and replaced by saline. On the other hand, no response may simplymean that the patient is addicted to and tolerant of narcotics and thattoo is worth noting. An unpredicted response does not prove anything butmultiple unpredicted responses in multiple patients can be suspicious.Therefore, aggregating or analyzing data over time for a particularpatient or provider can alert management to issues. If any individualprovider traverses a threshold number of flags (e.g., too many “flags”)for unexpected physiologic responses (including no response), theautomated data consolidation module 100, 200, 400, 600, 800 can generatean alert to notify management and an investigation of that provider maybe warranted. Knowing that AI is “watching” the patients' response to ahealthcare providers' injected medications, can be a significantdeterrent to tempted drug thieves.

Technique 2300 can include determining if one or more unexpectedphysiological events has occurred, analyzing saving, aggregating anddisplaying such information, in any order. The method can be performedby processing circuitry 157, 257, 1502, including other processingcircuitry, memories and databases in electrical communication withprocessing circuitry 157, 257, 1502 to one or more of: receivephysiologic data, analyze physiologic data, determine physiologic datais unexpected, create and send instructions to cause an alert to theprovider or another user, or save a physiological event information to astorage device 1516 which may include a database. The physiologicalevent information can include, but not limited to data generated by thevarious sensors and equipment described herein, including one more of:physiological information, patient information, provider information,medication information, time information, location information, facilityinformation, equipment information, aggregated physiological eventinformation and analyzed physiologic event information.

Operation 2302 can include receiving physiologic data from a physiologicsensor, Operation 2304 can include analyzing the physiologic data.Operation 2304 can include comparing the physiologic data to expectedphysiologic responses. Based on the outcome of the analysis in operation2304, in operation 2306, the processing circuitry can determine if thephysiologic data is unexpected, and if so, operation 2308 can includesaving unexpected physiologic event information to one or more storagedevices, or can include sending instructions to one or more displays todisplay unexpected physiologic event information.

Operation 2310 can include aggregating or analyzing physiologic eventinformation from a plurality of unexpected physiological events andgenerating aggregated or analyzed physiologic event information. In someexamples, aggregating can include aggregating a number of physiologicalevents by counting the number of physiological events for a givenprovider, patient, group of patients, medical facility, type ofmedication, or any other suitable assessment. Operation 2312 can includesaving aggregated or analyzed physiologic event information to one ormore storage devices or sending instructions to one or more displays todisplay aggregated or analyzed physiologic event information. In someexamples, the physiologic event information can include any type ofphysiologic event that occurs, including expected or desirablephysiologic events

The operations of technique 2300 can help provide safer care forpatients, including providing narcotic medications when helpful, whilekeeping a close eye on drug abuse by providers or patients. Taken at ahigh level, technique 2300 can help medical facilities evaluate whichmedications are most often abused by patients or stolen by providers,and to mitigate risk for insurers.

Any operations of the various methods described herein can be used incombination with or separately from one another, depending on thedesired features and in consideration of constraints such as financial,space, material and manufacturing availability.

The above detailed description includes references to the accompanyingdrawings, which form a part of the detailed description. The drawingsshow, by way of illustration, specific embodiments in which theinvention can be practiced. These embodiments are also referred toherein as “examples.” Such examples can include elements in addition tothose shown or described. However, the present inventors alsocontemplate examples in which only those elements shown or described areprovided. Moreover, the present inventors also contemplate examplesusing any combination or permutation of those elements shown ordescribed (or one or more aspects thereof), either with respect to aparticular example (or one or more aspects thereof), or with respect toother examples (or one or more aspects thereof) shown or describedherein.

In this document, the terms “a” or “an” are used, as is common in patentdocuments, to include one or more than one, independent of any otherinstances or usages of “at least one” or “one or more.” In thisdocument, the term “or” is used to refer to a nonexclusive or, such that“A or B” includes “A but not B,” “B but not A,” and “A and B,” unlessotherwise indicated. In this document, the terms “including” and “inwhich” are used as the plain-English equivalents of the respective terms“comprising” and “wherein.” Also, in the following claims, the terms“including” and “comprising” are open-ended, that is, a system, device,article, composition, formulation, or process that includes elements inaddition to those listed after such a term in a claim are still deemedto fall within the scope of that claim. Moreover, in the followingclaims, the terms “first,” “second,” and “third,” etc. are used merelyas labels, and are not intended to impose numerical requirements ontheir objects. The terms approximately, about or substantially aredefined herein as being within 10% of the stated value or arrangement.

The above description is intended to be illustrative, and notrestrictive. For example, the above-described examples (or one or moreaspects thereof) may be used in combination with each other. Otherexamples can be used, such as by one of ordinary skill in the art uponreviewing the above description. The Abstract is provided to allow thereader to quickly ascertain the nature of the technical disclosure. Itis submitted with the understanding that it will not be used tointerpret or limit the scope or meaning of the claims. Also, in theabove Detailed Description, various features may be grouped together tostreamline the disclosure. This should not be interpreted as intendingthat an unclaimed disclosed feature is essential to any claim. Rather,inventive subject matter may lie in less than all features of aparticular disclosed example. Thus, the following claims are herebyincorporated into the Detailed Description as examples or examples, witheach claim standing on its own as a separate example, and it iscontemplated that such examples can be combined with each other invarious combinations or permutations. The scope of the invention shouldbe determined with reference to the appended claims, along with the fullscope of equivalents to which such claims are entitled.

NOTES AND VARIOUS EXAMPLES

Each of these non-limiting examples may stand on its own, or may becombined in various permutations or combinations with one or more of theother examples. The examples are supported by the preceding writtendescription as well as the drawings of this disclosure.

Example 1 is an automated data consolidation module including a modulefor housing waste-heat producing electronic and electromechanicalmedical equipment and a system to receive and record data produced bythe electronic and electromechanical medical equipment, the automateddata consolidation module comprising: a housing configured to house theelectronic and electromechanical medical equipment; a cowling thatsubstantially confines waste heat generated by the electronic andelectromechanical medical equipment; and processing circuitry inelectrical communication with the electronic and electromechanicalmedical equipment to receive digital data produced by the electronic andelectromechanical medical equipment; wherein the digital data isautomatically delivered to the processing circuitry, and the processingcircuitry is configured to automatically save the digital data to anelectronic record or database.

In Example 2, the subject matter of Example 1 optionally includeswherein data produced by the electronic and electromechanical medicalequipment mounted in or on the module can be automatically consolidatedby the processing circuitry in electrical communication with theelectronic and electromechanical medical equipment.

In Example 3, the subject matter of any one or more of Examples 1-2optionally include wherein data produced by the electronic andelectromechanical medical equipment mounted near the module can beautomatically consolidated by the processing circuitry in wired orwireless electrical communication with the electronic andelectromechanical medical equipment.

In Example 4, the subject matter of any one or more of Examples 1-3optionally include wherein the electronic and electromechanical medicalequipment mounted in or on the module can be required to produce digitaldata that one or more of conforms to a specific data standard, is inspecific data formats, fills in specific data fields for each type ofelectronic and electromechanical medical equipment and is deliveredinstantly to the processing circuitry.

In Example 5, the subject matter of any one or more of Examples 1-4optionally include wherein the processing circuitry is configured tostructure and organize the consolidated data from the electronic andelectromechanical medical equipment so that it can most effectivelypopulate a “big data” database for subsequent “big data” analytics.

In Example 6, the subject matter of Example 5 optionally includeswherein the processing circuitry is configured to translate data thatdoes not conform to a specific data standard or specific data formats.

In Example 7, the subject matter of any one or more of Examples 5-6optionally include wherein the processing circuitry is configured to addtime stamps or other indicators of time so that unrelated data can betemporally correlated during subsequent “big data” analysis.

In Example 8, the subject matter of any one or more of Examples 5-7optionally include wherein the processing circuitry is configured todetermine if a continuous recording of a data stream is desirable andthen continuously record or if intermittent recording of data isadequate in the case of slow-changing or non-changing data, to recordintermittently.

In Example 9, the subject matter of any one or more of Examples 5-8optionally include wherein the processing circuitry is configured to dodata preparation including filtering and cleaning so that the datasubmitted to a “big data” database is accurate and complete.

In Example 10, the subject matter of Example 9 optionally includeswherein the filtering and cleaning includes comparing data from severalsensors using Sensor Fusion in order to detect clearly erroneous datafrom a faulty sensor or faulty connection.

In Example 11, the subject matter of any one or more of Examples 5-10optionally include wherein the processing circuitry is configured toperform one or more of batch processing and stream processing to thedata.

In Example 12, the subject matter of any one or more of Examples 5-11optionally include wherein the processing circuitry is configuredperform as a processing node in a “big data” parallel processing system.

Example 13 is an automated data consolidation module comprising: ahousing configured to house waste heat-producing electronic andelectromechanical medical equipment; a cowling that substantiallyconfines waste heat generated by the waste heat-producing electronic andelectromechanical medical equipment; a system to receive and record dataproduced by the electronic and electromechanical medical equipment; andprocessing circuitry in electrical communication with the electronic andelectromechanical medical equipment to receive digital data produced bythe electronic and electromechanical medical equipment; wherein thedigital data is automatically delivered to the processing circuity, andthe processing circuitry is configured to temporally correlate thedigital data and automatically save the temporally-correlated digitaldata to an electronic record or database.

In Example 14, the subject matter of Example 13 optionally includeswherein data produced by the electronic and electromechanical medicalequipment mounted in or on the module can be automatically consolidatedby the processing circuitry in electrical communication with theelectronic and electromechanical medical equipment.

In Example 15, the subject matter of any one or more of Examples 13-14optionally include wherein data produced by the electronic andelectromechanical medical equipment mounted near the module can beautomatically consolidated by the processing circuitry in wired orwireless electrical communication with the electronic andelectromechanical medical equipment.

In Example 16, the subject matter of any one or more of Examples 13-15optionally include wherein the processing circuitry is configured tostructure and organize the consolidated data from the electronic andelectromechanical medical equipment so that it can most effectivelypopulate a “big data” database for subsequent “big data” analytics.

In Example 17, the subject matter of Example 16 optionally includeswherein the processing circuitry is configured to translate data thatdoes not conform to a specific data standard or specific data formats.

In Example 18, the subject matter of any one or more of Examples 16-17optionally include wherein the processing circuitry is configured to addtime stamps or other indicators of time so that unrelated data can betemporally correlated during subsequent “big data” analysis.

In Example 19, the subject matter of any one or more of Examples 16-18optionally include wherein the processing circuitry is configured todetermine if a continuous recording of a data stream is desirable andthen either (a) continuously record or (b) record intermittently in thecase of slow-changing or non-changing data if intermittent recording ofdata is adequate.

In Example 20, the subject matter of any one or more of Examples 16-19optionally include wherein the processing circuitry is configured to dodata preparation including filtering and cleaning so that the datasubmitted to a “big data” database is accurate and complete.

In Example 21, the subject matter of Example 20 optionally includeswherein the filtering and cleaning includes comparing data from severalsensors in a technique called Sensor Fusion in order to detect clearlyerroneous data from a faulty sensor or faulty connection.

In Example 22, the subject matter of any one or more of Examples 16-21optionally include wherein the processing circuitry is configured toperform one or more of batch processing and stream processing to thedata.

In Example 23, the subject matter of any one or more of Examples 16-22optionally include wherein the processing circuitry is configuredperform as a processing node in a “big data” parallel processing system.

Example 24 is an automated data consolidation module including a modulefor housing unrelated electronic and electromechanical surgicalequipment including a system to receive and record data produced by theelectronic and electromechanical medical equipment, the automated dataconsolidation module comprising: a housing having a lower section and atower-like upper section, wherein the lower section is configured tohouse unrelated electronic and electromechanical surgical equipment, andwherein the tower-like upper section is located on top of the lowersection, wherein the upper section is configured to accommodate mountingof equipment controls, display screens and monitor screens at aconvenient height for viewing and operating; a cable and hose managementsystem located on a patient side of the module, wherein the patient sideof the module is configured to face a patient and provide the closestand most direct access to the patient; and processing circuitry inelectrical communication with the electronic and electromechanicalmedical equipment to receive digital data produced by the electronic andelectromechanical medical equipment; wherein the digital data isautomatically delivered to the processing circuitry, and the processingcircuitry is configured to temporally correlate the digital data andautomatically save the temporally-correlated digital data to anelectronic record or database.

In Example 25, the subject matter of Example 24 optionally includeswherein data produced by the electronic and electromechanical medicalequipment mounted in, on or near the module can be automaticallyconsolidated by the processing circuitry in wired or wireless electricalcommunication with the electronic and electromechanical medicalequipment.

In Example 26, the subject matter of any one or more of Examples 24-25optionally include wherein the processing circuitry is configured tostructure and organize the consolidated data from the electronic andelectromechanical medical equipment so that it can most effectivelypopulate a “big data” database for subsequent “big data” analytics.

In Example 27, the subject matter of Example 26 optionally includeswherein the processing circuitry is configured to translate data thatdoes not conform to a specific data standard or specific data formats.

In Example 28, the subject matter of any one or more of Examples 26-27optionally include wherein the processing circuitry is configured to dodata preparation including filtering and cleaning so that the datasubmitted to a “big data” database is accurate and complete.

In Example 29, the subject matter of Example 28 optionally includeswherein the filtering and cleaning includes comparing data from severalsensors in a technique called Sensor Fusion in order to detect clearlyerroneous data from a faulty sensor or connection.

Example 30 is an automated data consolidation module including a modulefor housing one or more of electronic and electromechanical medicalequipment and a system to measure and record administration of one ormore IV medications or fluids for IV administration and a system toreceive and record data produced by the electronic and electromechanicalmedical equipment, the automated data consolidation module comprising: ahousing configured to house one of more of electronic andelectromechanical medical equipment; a cowling that substantiallyconfines the one or more of electronic and electromechanical medicalequipment; and a system for measuring and recording the administrationof the one or more IV medications and fluids, the system comprising: abarcode reader or an RFID interrogator configured to identify at leastone of the one or more IV medications or fluids; and a machine visiondigital camera in electrical communication with processing circuitryconfigured to determine a volume of medication administered from asyringe or fluid administered from an IV bag through an IV drip chamberinto an IV tubing based on an image generated by the machine visiondigital camera; and processing circuitry in electrical communicationwith the electronic and electromechanical medical equipment and thesystem for measuring and recording the administration of the one or moreIV medications and fluids to receive digital data produced by theelectronic and electromechanical medical equipment and system formeasuring and recording the administration of the one or more IVmedications and fluids; and wherein the digital data is automaticallydelivered to the processing circuitry, and the processing circuitry isconfigured to automatically save the digital data to an electronicrecord or database.

What is claimed is:
 1. An automated data consolidation modulecomprising: a housing configured to house electronic andelectromechanical medical equipment; one or more machine vision digitalcameras configured to generate dose event images and response eventimages; and processing circuitry and software in electricalcommunication with the electronic and electromechanical medicalequipment and the one or more machine vision digital cameras, theprocessing circuitry and software configured to receive data produced bythe electronic and electromechanical medical equipment and the one ormore machine vision digital cameras, the data including dose event databased on the dose event images and response event data based on theresponse event images; wherein the data is automatically delivered tothe processing circuitry, and the processing circuitry and software areconfigured to automatically add timestamps to the data and store thedose event data and the response event data to a database.
 2. Theautomated data consolidation module of claim 1, wherein the processingcircuitry is configured to temporally correlate the dose event data andthe response event data prior to storage of the data.
 3. The automateddata consolidation module of claim 1, wherein the response event datarecorded includes data representing, with respect to a patient: smiling,grimacing, lacrimation (tearing), coughing, skin color changes, remoteplethysmography, movement, restlessness or getting out of bed withoutassistance, changes in a breathing pattern, or changes in mood.
 4. Theautomated data consolidation module of claim 3, wherein the processingcircuitry is configured to perform remote plethysmography (rPPG) usingthe data to remotely monitor vital signs including heart rate,respiration rate, blood oxygenation saturation, or temperature usingvisible light and Red Green Blue (RBG) cameras or using near-infraredlight (NIR) and NIR cameras.
 5. The automated data consolidation moduleof claim 3, wherein the processing circuit is configured to performremote plethysmography (rPPG) using the data to remotely measure bloodcomponents such as blood glucose and hemoglobin levels using visiblelight and Red Green Blue (RBG) cameras or using near-infrared light(NIR) and NIR cameras.
 6. The automated data consolidation module ofclaim 1, wherein the response event data recorded by the one or moremachine vision digital camera includes AI recognition and identificationof patient moods.
 7. The automated data consolidation module of claim 1,comprising light sources configured to produce visible light andnear-infrared light (NIR), the light sources attached to the moduleabove a head of a patient while the patient is laying on a surgicaltable or a hospital bed, optimizing a digital image by optimizing thelighting for a Red Green Blue (RBG) camera or NIR camera.
 8. Theautomated data consolidation module of claim 1, wherein the processingcircuitry and software are configured to structure and organizeconsolidated data based on the data from the electronic andelectromechanical medical equipment and the one or more machine visiondigital cameras.
 9. The automated data consolidation module of claim 1,wherein the dose event data includes video observation of a patient withAI and/or ML analysis to produce dose analysis data that represents,with respect to the patient: intubation, mash ventilation, pulmonarypercussion, airway suctioning, feeding, repositioning the patient orassisting the patient.
 10. An automated data consolidation moduleincluding a module for housing electronic and electromechanical surgicalequipment including a system to receive and record data produced byelectronic and electromechanical medical equipment, the automated dataconsolidation module comprising: electronic and electromechanicalsurgical equipment; a housing configured to support the electronic andelectromechanical surgical equipment; a cable and hose management systemlocated on a patient side of the module, wherein the patient side of themodule is configured to face a patient; one or more digital camerasconfigured to generate dose event data and response event data based onimagery observed by the one or more digital cameras; and processingcircuitry in electrical communication with the electronic andelectromechanical medical equipment and the one or more digital cameras,the processing circuitry configured to receive digital data produced bythe electronic and electromechanical medical equipment and receive thedose event data and the response event data; wherein at least one of theone or more digital cameras is mounted to the module by a movable armconfigured to position the one or more digital cameras above a face ofthe patient when the patient is laying supine on a surgical table or ahospital bed; and wherein the digital data is automatically delivered tothe processing circuitry, wherein the processing circuitry and softwareare configured to automatically add timestamps to the digital data, thedose event data, and the response event data, and wherein the processingcircuitry is configured to save the dose event data, the response eventdata, and the processed digital data to a database for temporalcorrelation of the dose events and response events during big dataanalytics or clinical decision support functions.
 11. The automated dataconsolidation module of claim 10, wherein the dose event data includesAI and/or ML analysis of the dose event data to produce dose eventanalysis regarding the patient, indicative of: intubation, maskventilation, pulmonary percussion, airway suctioning, feeding,repositioning the patient, or assisting the patient.
 12. The automateddata consolidation module of claim 10, wherein the response event datarecorded by the one or more digital cameras is indicative of, withregard to the patient: smiling, grimacing, lacrimation (tearing),coughing, skin color changes, remote plethysmography, movement,restlessness or getting out of bed without assistance, change in abreathing pattern, or change in mood.
 13. The automated dataconsolidation module of claim 12, wherein the processing circuitry isconfigured to perform remote plethysmography (rPPG) to remotely monitorvital signs o the patient including heart rate, respiration rate, bloodoxygenation saturation, or temperature using visible light and Red GreenBlue (RBG) cameras or using near-infrared light (NIR) and NIR cameras.14. The automated data consolidation module of claim 12, wherein theprocessing circuitry is configured to perform remote plethysmography(rPPG) to remotely measure blood components such as blood glucose andhemoglobin levels using visible light and Red Green Blue (RBG) camerasor using near-infrared light (NIR) and NIR cameras.
 15. The automateddata consolidation module of claim 10, wherein the processing circuitryand software is configured to perform AI recognition and identificationof patient moods based on the response event data.
 16. The automateddata consolidation module of claim 10, comprising light sourcesincluding visible light and near-infrared light (NIR) that are attachedto the movable arm, the movable arm configured to position the lightsources directly above a head of a patient when the patient is laying ona surgical table or a hospital bed, optimizing the digital image byoptimizing the lighting for a Red Green Blue (RBG) camera or an NIRcamera.
 17. The automated data consolidation module of claim 10, whereinthe processing circuitry and software is configured to structure andorganize data from the electronic and electromechanical medicalequipment and the one or more machine vision digital cameras to producedconsolidated data to populate a big data database for subsequent bigdata analytics.
 18. An automated data consolidation module including amodule for housing electronic and. electromechanical medical equipmentand mounting one or more machine vision digital cameras, including asystem to receive and record data produced by the electronic andelectromechanical medical equipment and machine vision digital cameras,the automated data consolidation module comprising: a housing configuredto house electronic and electromechanical medical equipment; a cowlingthat substantially confines the electronic and electromechanical medicalequipment; a patient side of the module configured to be oriented towarda patient and provide direct access to the patient; a camera configuredto generate dose event images and response event images; and processingcircuitry and software in electrical communication with the electronicand electromechanical medical equipment and the camera, the processingcircuitry and software configured to receive data from theelectromechanical medical equipment; wherein at least one of the camerais mounted to the module by a movable arm configured to position thecamera above a face of the patient when the patient is laying supine ona surgical table or a hospital bed near the module; and wherein the datais automatically delivered to the processing circuitry, and theprocessing circuitry and software are configured to produce dose eventdata based on the dose event images and produce response event databased on the response event images, the processing circuitry configuredto automatically add timestamps to the digital data, the dose eventdata, and the response event data, and configured to save the data, thedose event data, and the response event data to an electronic record ordatabase for temporal correlation of the dose events and response eventsduring big data analytics or clinical decision support functions. 19.The automated data consolidation module of claim 18, wherein theresponse event data recorded by the digital camera is indicative of,with regard to the patient: smiling, grimacing, lacrimation (tearing),coughing, skin color changes, remote plethysmography, movement,restlessness or getting out of bed without assistance, change in abreathing pattern, or change in mood.
 20. The automated dataconsolidation module of claim 19, wherein the processing circuitry isconfigured to perform remote plethysmography (rPPG) to remotely monitorvital signs of heart rate, respiration rate, blood oxygenationsaturation, or temperature using visible light and Red Green Blue (RBG)cameras or using near-infrared light (NIR) and NIR cameras.
 21. Theautomated data consolidation module of claim 19, wherein the processingcircuitry is configured to perform remote plethysmography (rPPG) toremotely measure blood characteristics of blood glucose and hemoglobinlevels using visible light and Red Green Blue (RBG) cameras or usingnear-infrared light (NIR) and NIR cameras.
 22. The automated dataconsolidation module of claim 18, wherein light sources include visiblelight and near-infrared light (NIR) and are attached to the movable armthat can position the light sources directly above a head of the patientwhile the patient is laying on a surgical table or a hospital bed,optimizing the digital image by optimizing the lighting for a Red GreenBlue (RBG) camera or NIR camera.
 23. An automated data consolidationmodule comprising: a housing configured to house electronic andelectromechanical medical equipment; and a system to receive and recorddigital data produced by the electronic and electromechanical medicalequipment, the system including processing circuitry in electricalcommunication with the electronic and electromechanical medicalequipment to receive the digital data produced by the electronic andelectromechanical medical equipment, the digital data including doseevent data and response event data collected by the system; wherein thedigital data is automatically delivered to the processing circuitry, andthe processing circuitry is configured to timestamp the digital data andsave the timestamped digital data to an electronic record or databasefor temporal correlation of the dose events and response events duringbig data analytics or clinical decision support functions.
 24. The auto.ed data consolidation module of claim 23, wherein the electronic andelectromechanical medical equipment is mounted in or on the module, andwherein the data produced by the electronic and electromechanicalmedical equipment is automatically consolidated by the processingcircuitry in electrical communication with the electronic andelectromechanical medical equipment.
 25. The automated dataconsolidation module of claim 23, wherein electronic andelectromechanical medical equipment is mounted near the module, andwherein the data produced by the electronic and electromechanicalmedical equipment is automatically consolidated by the processingcircuitry in wired or wireless electrical communication with theelectronic and electromechanical medical equipment.